Spinal tuberculosis in children

Objectives To review our experience of spinal tuberculosis (TB) at a major UK paediatric tertiary referral centre.

Methods The authors performed a retrospective case survey of 21 patients admitted to Great Ormond Street Hospital over a 15-year period (1995–2010) with confirmed or presumed spinal TB. Data were collected concerning demographics, clinical, laboratory and radiological characteristics, treatment and clinical outcome.

Results Only one patient was of Caucasian origin. Four (19%) had a previous diagnosis of TB, 11 (52%) a known contact, 10 (48%) had received BCG vaccine and none were HIV-positive. Clinical presentations included systemic symptoms (18 patients), back pain (16 patients), deformity (five patients) and neurological deficits (12 patients). Mycobacterium tuberculosis was isolated from 14 patients (67%) including one multi-drug resistant strain. Spinal cord compression or critical stenosis was demonstrated in eight patients (38%). All received TB treatment for at least 12 months; six patients received treatment for a longer period. Seven (33%) underwent surgical intervention. Seventy-five per cent showed clinical and radiological resolution after treatment. No patients died or suffered long-term neurological deficit.

Conclusions Spinal TB in children needs a high index of suspicion for diagnosis. Early referral to an expert centre allows a multidisciplinary approach to management. The authors recommend that treatment should be individually tailored and may need to exceed 12 months in cases of poor adherence, extensive disease or drug resistance.