Tuberculous Spondylitis: A Comprehensive Review of Epidemiology, Diagnosis, and Management

Abstract

Tuberculous spondylitis, a manifestation of tuberculosis (TB) in the spine, remains a significant health issue globally, with a prevalence that continues to rise, particularly in developing countries like Indonesia. Spinal tuberculosis arises from hematogenous spread, often originating in pulmonary or genitourinary systems, and can lead to vertebral destruction, deformity, and neurological deficits. Diagnosis is confirmed through clinical symptoms, imaging (MRI and X-rays), and microbiological tests. Spinal TB typically presents with chronic back pain, stiffness, and systemic symptoms like fever, night sweats, and weight loss. Advanced cases may develop neurological complications, including radiculopathy and paraplegia. Identification and management are crucial to prevent long-term disability, such as kyphosis and neurological impairment. Management primarily involves long-term anti-TB therapy (9-12 months) and, in certain cases, surgical intervention. Non-operative approaches are preferred in early or stable cases, involving anti-TB drugs and spinal immobilization. Surgery becomes necessary for severe deformities, abscesses, or neurological compromise. Surgical approaches include anterior, posterior, or combined methods aimed at spinal stabilization and deformity correction. Despite advances, challenges remain in managing complications, such as neurological deficits and progressive deformities, which may require complex surgical solutions. Multidisciplinary care, including collaboration among orthopedic, neurological, and infectious disease specialists, is essential for optimizing treatment outcomes. Diagnosis, effective anti-TB therapy, and timely surgical intervention are key to improving patient outcomes and preventing permanent disability.