Researchers at Great Ormond Street Hospital for Children and Institute of Child Health, London, UK reviewed their experience of childhood spinal tuberculosis (TB) over a 15-year period (1995-2010). Of 21 patients identified (median age 9.7 years, range 3.4-15.9 years) 11 were Black African, 7 Asian, 2 Middle Eastern and 1 Caucasian. Nine were born in the UK, 1 in the Netherlands and the remainder outside Europe. Ten had traveled to a country endemic for TB within the year before diagnosis. Four (19%) had a previous diagnosis of TB, 11 (52%) a known contact, 10 (48%) had received BCG vaccine and none was HIV-positive. Clinical presentations included systemic symptoms in 18 (night sweats, weight loss, fever and anorexia), back pain in 16, neurological symptoms in 12 (weakness and limp in 7, sensory change in 5), and spinal deformity in 5. Mycobacterium tuberculosis was isolated in 14 patients (67%) by vertebral biopsy or from paraspinal abscess. Spinal cord compression or stenosis occurred in 8 (38%), vertebral collapse in 13 (62%), and paraspinal abscess in 15 (71%). Chest x-ray showed TB lung disease in 8 patients (38%). Extra-spinal disease was co-existent in 12 (57%) patients, including psoas abscess in 5 (24%). All patients received TB treatment for at least 12 months, 7 underwent surgery, and 75% resolved fully. All patients were alive and without neurologic deficit at a median follow-up of 24 months. [1]

COMMENT. The authors list key features that should alert the clinician to a diagnosis of spinal TB: TB contact or travel to endemic area, history of previous TB, systemic symptoms, back pain and long duration of symptoms. Treatment should be supervised closely and prolonged. Late onset paraplegia, a feature of Pott’s disease, was not a complication in the authors’ cases. In a series of 8 patients with late onset Pott’s paraplegia due to kyphosis, this complication was treated successfully with decompression and grafting. A mean period of 24 years (range, 9-46 years) had elapsed from the onset of active disease and the age at neurological deterioration [2]. This report re-emphasizes the need for long-term antibacterial therapy, careful follow-up and monitoring with spinal x-ray and neurologic evaluation, as indicated in the Great Ormond Street experience of spinal TB.