Abstract
Background: Tuberculosis continues to increase in England, Wales and Northern Ireland. The London region accounted for a substantial proportion of cases in 2005 (43%) and had the highest rate of disease (46.3 per 100,000). Skeleton is a common site of predilection. However, diagnostic evaluation of vertebral TB is hampered by the difficulty of MRI interpretation and failing to keep a high index of suspicion.
Methods: Cross sectional sampling of all patients with confirmed vertebral TB between the years of 1999–2006 in two large London hospitals covering; Royal London Hospital and King George Hospital. Various dermographic parameters were evaluated. The mode of presentation, surgical procedures and outcome of patients were highlighted.
Results: One hundred and twenty three patients were identified with a Mean age of thirty four years. Male and female was 55%, 45% respectively. Asians represent the highest immigrant group followed by Afrocarbian at 63%, 28% respectively. White British represents only 6.5%. The dorsal spine was the most commonly affected site at 45%, then lumbar spine in 33% followed by multiple regions in 11%. Delayed diagnosis was made in 34% of patients, 44% of them over six months.
Back pain/neck pain was the presenting complaint in 100% whereas neurological signs were found in 37% and systemic manifestations present in 38%. To control the disease, spinal surgical procedures was needed in 44% of cases. Approximately 30% of them had partial recovery and 9% had complete recovery.
Conclusions: The incidence of vertebral TB is on the increase. A high index of suspecion is required to avoid delay in the diagnosis. Knowledge of the patients’ background may help making approperiate early referral for MRI especially among Asian groups.
Correspondence should be addressed to Mr J. O’Dowd, Honorary Secretary at SBPR c/o BOA, Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE.
