Introduction:

Spinal tuberculosis (TB) is rare and often diagnosed late and is associated with an increased risk of morbidity and mortality.

Methods:

We conducted a retrospective study of consecutive patients attending a Spinal clinic at a large London Hospital. Information on demographics, clinical disease manifestation at diagnosis and radiological findings were recorded.

Results:

102 cases with spinal TB were identified during 2010-2022. 36 cases were excluded due to incomplete data. 43(65%) patients were male and median age was 28 years (10.5 IQR). 18(27%) patients were from India, 14(21%) Bangladesh, 12(18%) Pakistan, 10(15%) UK, 6(9%) Africa and 1(1%) from the Caribbean. 62/66(93%) were HIV negative.

58/66(87%) patients had back or neck pain as their primary symptom. 35(53%) had weight loss followed by night sweats 25(37%), fever 18(27%). 7(10%) had a spinal deformity at presentation. 20(30%) had sensory symptoms,18(27%) had motor symptoms and 5(7%) had urinary symptoms.

All patients had a MRI whole spine performed at diagnosis. 35(53%) had multiple spinal level involvement. The most common level was the thoracic spine 44(66%), followed by lumbar 36(54%), cervical 13(19%) and sacral spine 11(16%). 46(69%) had Image guided biopsy and only 5(7%) had an open biopsy.14 (21%) had Granulomatous changes on histology. AFB smear was positive in 13 (19%). 50(75%) were culture positive for Mycobacterium Tuberculosis. PCR was positive in 4 cases. 60 patients (90%) completed treatment successfully.

Conclusion:

A third of patients had sensory and motor symptoms at presentation suggesting a delay in diagnosis. Patients with unexplained back pain from high TB incidence countries should be investigated for spinal TB.