OUR EXPERIENCE OF THE MANAGEMENT OF SPINAL TUBERCULOSIS (TB) IN EAST LONDON, UK: A CASE SERIES OF 107 PATIENTS OVER 10 YEARS

Abstract

Introduction: Tuberculosis (TB) continues to cause a sig-nificant burden of disease in the United Kingdom (UK). The incidence of TB in London is four times greater than the national average, with almost half of the 7000 cases/year seen nationwide being found in the capital. Although the majority of cases are pulmonary, extra-pulmonary infection is not uncommon.

Methods: We reviewed 107 patients treated for spinal TB in East London, UK, between 1997–2006. 59 were male and 48 were female. Their mean age was 39.9 (6–89). 69 patients were Asian, 26 African, 10 UK-born Caucasian, 1 other European and 1 Middle Eastern. Rates of HIV co-infection are inexact as many declined to be tested.

All patients presented with symptomatic back pain, with or without neurological compromise.

All patients had appropriate pre and post treatment imaging. 100 had microbiological and/or histological confirmation of TB. The disease was predominantly in the thoraco-lumbar spine, although cervical involvement was seen in 5%. All patients presented with anterior column involvement, with psoas abscesses in 30%.

Combination chemotherapy, according to British Thoracic Society guidelines, was the main modality of treatment. Surgery was performed for certain indications: deteriorating neurology, instability and post tubercular kyphosis. 15% of the 107 patients treated required surgical intervention.

Results: There were no deaths related to TB or our intervention. Most patients had full neurological recovery, but a small percent had permanent neurological compromise. There was a high incidence of persistent chronic back pain for which patients continued to seek medical advice.

Conclusion: Medical management is the mainstay of treatment for spinal TB, but there are certain circumstances where surgical intervention will be required. Because of the high incidence of spinal TB in East London and in order to standardise treatment of these patients, 2 years ago we set up what we believe to be the only dedicated multidisciplinary spinal TB clinic in the UK. Patients are managed jointly by the respiratory and orthopaedic teams.