REVIEW OF SPINAL TUBERCULOSIS IN EAST LONDON

Abstract

Tuberculosis continues to increase in England. London accounted for a substantial proportion of cases in 2005 (43%) and had the highest rate of disease. Spinal TB is the most common skeletal manifestation. The diagnostic evaluation of spinal TB is hampered by the difficulty of MRI interpretation and failing to keep a high index of suspicion.

The mode of presentation of spinal tuberclosis, surgical procedures and outcome of patients were highlighted. Various dermographic parameters were evaluated.

A prospective cohort study was conducted. Cross sectional sampling of patients presented with spinal TB between the years of 1999–2006 in two main hospitals covering large population of East London, Royal London Hospital and King George Hospital.

One hundred and twenty three patients (mean age: 34 years) were identified. Asians represent the highest group affected (63%), then appear Afrocarribean (28%). White British represent only 6.5%. Frequency of occurence was as follows: dorsal spine 45%, lumbar spine 33%, multiple regions 11%. Delayed diagnosis was made in 34% of patients, 44% of whom were over 6/12.

Backpain or neckpain was the presenting complaint in all of the patients (100%), whereas neurological signs were found in 37%. Systemic manifestations presented in 38%. Spinal surgical procedures were needed in 44% of cases. Approximately 30% of them had partial recovery and 9% had complete recovery.

The incidence of spinal 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 appropriate early referral for MRI.