Background Osteo-aticular tuberculosis represents 2 to 5% of all tuberculosis. Tuberculous spondylitis arise at any age. Dorsolumbar location is most frequently touched and clinical presentation is not specific. The MRI presents a superior to other radiological exams in the exploration of tuberculous spondylitis.
Objectives The purpose of our study is to specify epidemiological, clinical, biological and therapeutic peculiarities of Tuberculous Spondylitis in Tunisian patients.
Methods A retrospective and descriptive analysis including patients with tuberculous spondylitis followed in the department of internal medicine during a period of 15 years from January 2000 till January 2015. Tuberculin skin test, imaging techniques, mycobacterium cultures, histopathologic examination, treatment and clinical outcome were reported. Diagnosis was retained in front of positive bacteriological or histopathological exams and/or association of clinico-biological or radiologic arguments with therapeutic proof.
Results We identified 13 patients with tuberculous spondylitis. It was about 9 women and 4 men with a middle-age at the time of diagnosis of 53, 4 years with extremes between 13 and 90 years. The mean diagnosis delay was 7,4 months. Main initial symptoms were back pain in 11 cases, mobility limitation in 6 cases and dysphagia in a case. Blood tests showed leukocytisis in a case an elevated C-reactive protein levels in 9 cases. Tuberculin skin test was positive in 7 cases. Bacterial diagnosis was positive in a case. Granuloma with necrosis was noted at the histopathologic examination of the bonedraining biopsy in 3 cases. Radiologic exams contained standard spinal radiographs in 7 cases, Computed tomography scanning in 7 cases and magnetic resonance imaging in 6 cases. The imaging examination showed signs of lytic destruction of vertebral body with vertebral collapse in all cases, and multiple abscesses in 5 cases. Spondylitis was located in thoracic vertebra in 6 cases, lumbar vertebra in 6 cases and cervical vertebra in a case. Other locations of the tuberculosis were noted in 5 cases and were represented by lymph nodes, meningeal, peritoneal, retropharyngeal and urogenital tuberculosis. All the patients were treated by a tuberculosis quadritherapy. A patient received corticosteroids for spine involvement. The median duration of the treatment was of 16 months. The outcome was favourable in all cases with stabilization of the radiological involvement. The mean follow up was of 15,7 months
Conclusions Tuberculosis always rages under an endemic mode in developing contries. Inspite of the absence of immunosuppression, tuberculosis spondylitis was associated to other tuberculous locations in 5 cases. The beginning is often insidious with a late diagnosis. The association of clinical, biological and radiological arguments with therapeutic proof allowed to carry the diagnosis.
Disclosure of Interest None declared