CURRENT CONCEPTS ON SPINAL TUBERCULOSIS

Diagnosis is difficult in the initial stages, delay in diagnosis may lead to serious spinal cord injuries Predisposing factors include malnutrition, alcoholism, diabetes, and human immunodeficiency virus (HIV) infection Symptoms are usually insidious, there may be complaints that have been going on for years before diagnosis Low back pain, fever, weight loss, and night sweats are the most common symptoms The diagnosis usually can be made on the basis of predisposing factors, history of TB disease, clinical findings and imaging methods However, the gold standard in diagnosis is positive Mycobacterium tuberculosis tissue culture Because of this, in the case of clinical suspicion, tissue culture should be performed. In addition, performing polymerase chain reaction in samples taken with biopsy, erythrocyte sedimentation rate (ESR), immunological hematological tests and skin test are helpful in diagnosis Radiography is preferred as the initial imaging method and the "bird's nest" appearance can be seen, evocative of an aortic aneurysmal phenomenon reflected from aortic pulsations Computed tomography (CT) can provide information on the extent of vertebral involvement. Abscess and intra-canal compression can be seen in the CT taken with intrathecal contrast The preferred imaging method for spinal cord TB is MRI. Typical findings include lesions in the vertebral end plates, anterior involvement in the vertebral body, subligamentous spreading, paraspinal cold (without signs of severe acute inflammation) abscesses and calcifications, vertebral bodies, vertebral body destruction and collapse but the disc is usually protected MRI findings can also be used in treatment follow-up, but pain reduction and neurological recovery are more important in follow-up treatment Javed et al.