Skeletal tuberculosis
Malcolm McDonald, PhD, FRACP, FRCPA
Daniel J Sexton, MD
Section Editors
Daniel J Sexton, MD
C Fordham von Reyn, MD
Deputy Editor
Elinor L Baron, MD, DTMH
Lastliterature review version 18.3: septiembre 2010 | This topic last updated: enero 21, 2010 (More)
INTRODUCTION — Tuberculosis (TB), including skeletal tuberculosis, is an ancient infection based uponevidence from remains.
* The typical features of spinal TB have been identified in Egyptian mummies dating back to almost 4000 BC [1].
* Analysis of 483 pre-Columbian skeletons from Chileshowed lesions consistent with bony tuberculosis in 2 percent [2].
* DNA analysis revealed Mycobacterium tuberculosis in a vertebral lesion of a 12 year-old girl who lived about 1000 AD [2].
Themajor clinical issues related to skeletal TB will be reviewed here.
EPIDEMIOLOGY — Bone and joint infection may account for 10 to 35 percent of cases of extrapulmonary tuberculosis and, overall, foralmost 2 percent of all cases of TB [3-7]. Musculoskeletal tuberculosis involves the spine in approximately one-half of patients. The next most common syndrome is tuberculous arthritis, followed infrequency by extraspinal tuberculous osteomyelitis [8].
* Spinal TB (Pott's disease) most often affects the lumbar and lower thoracic region; upper thoracic and cervical disease is less common butpotentially more disabling [9,10]. Tuberculous abscess, a complication of spinal TB, is frequently bilateral.
* Tuberculous arthritis tends to occur in the weight-bearing joints, the hip and theknee, and is usually monoarticular. However, multifocal lesions are reported in 10 to 15 percent of cases in developing countries [11].
A retrospective multicenter review from France of all cases ofmusculoskeletal tuberculosis from 1980 through 1994 documented 206 cases of which 103 involved the spine; 68 percent of these patients were foreign-born, the majority from Africa [12]. None of the...
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