Skip to main content
SpringerLink
Log in

History of Tuberculosis Spine (Post-ATT Era)

  • Chapter
  • First Online:
Tuberculosis of the Spine

  • 345 Accesses

Abstract

Throughout history, infectious diseases have plagued those undergoing surgery, but several landmark discoveries in the field of microbiology have significantly impacted on survival. Tuberculosis (TB) has been present for approximately 70,000 years. The discovery of effective TB drug therapy revolutionised the management of this ancient disease and led to an era of treatment re-evaluation. Prior to anti-tuberculosis therapy (ATT), there was no consensus on the management of TB spine and depending on the practitioner it was managed either conservatively or with surgical debridement. Both options yielded unpredictable and often unfavourable outcomes with high morbidity rates. It was not until the discovery of highly effective ATT that the management of spinal TB radically changed. It led to a surgical renaissance whereby surgeons initially performed increasingly invasive, complex surgery for TB spine under the protection of ATT therapy. After an era of reequibrilation, the results from several large trials comparing operative and non-operative showed that ATT was effective at treating spinal TB alone, leading surgeons to gradually narrow their indications for surgical intervention. With time, improvements in surgical instrumentation has led to less reliance on bone grafts, less invasive surgery, and better outcomes for those patients who do require an operation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. A short history of vaccination-clinical key [Internet]. [cited 2021 Feb 11]. Available from: https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323357616000018?scrollTo=%23hl0000363

  2. Rutkow I. The rise of modern surgery: an overview. In: Sabiston textbook of surgery [Internet]. 20th ed. Philadelphia, PA: Elsevier; 2017 [cited 2021 Feb 11]. p. 1–19. Available from: https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323299879000011

  3. Fleming A. On the antibacterial action of cultures of a penicillium, with special reference to their use in the isolation of B. influenzæ. Br J Exp Pathol. 1929 Jun;10(3):226–36.

    CAS  PubMed Central  Google Scholar 

  4. Gaynes R. The discovery of penicillin–new insights after more than 75 years of clinical use. Emerg Infect Dis. 2017 May;23(5):849–53.

    Article  PubMed Central  Google Scholar 

  5. Seddon HJ. Pott’s paraplegia: prognosis and treatment. BJS Br J Surg. 1935;22(88):769–99.

    Article  Google Scholar 

  6. Mercer W. Then and now: the history of skeletal tuberculosis. J R Coll Surg Edinb. 1964;10:243–54.

    Google Scholar 

  7. Schatz A, Bugle E, Waksman SA. Streptomycin, a substance exhibiting antibiotic activity against gram-positive and gram-negative bacteria.∗†. Proc Soc Exp Biol Med. 1944 Jan 1;55(1):66–9.

    Article  CAS  Google Scholar 

  8. Deroy MS, Fisher H. The treatment of tuberculous bone disease by surgical drainage combined with streptomycin. J Bone Joint Surg Am. 1952 Apr;34-A(2):299–330.

    Article  CAS  PubMed  Google Scholar 

  9. Cameron J, a. P, Robinson CLN, Robertson DE. The radical treatment of pott’s disease and pott’s paraplegia by extirpation of the diseased area and anterior spinal fusion. Am Rev Respir Dis. 1962 Jul 1;86(1):76–80.

    CAS  PubMed  Google Scholar 

  10. Menard V. Étude pratique sur le mal de Pott [Internet]. Paris: Hachette Livre BNF; [cited 2021 Feb 13]. Available from: https://www.leslibraires.fr/livre/4771677-etude-pratique-sur-le-mal-de-pott-masson-hachette-livre-bnf

  11. Müller W. Transperitoneale Freilegung der Wirbelsaule bei Tuberkuloser Spondylitis. Dtsch Ztschr Chir. 1906;85(128)

    Google Scholar 

  12. Ito H, Tsuchiya J, Asami G. A new radical operation for Pott’s disease. J Bone Jt Surg. 1934;16(3):499–515.

    Google Scholar 

  13. Calot: Sur le meilleur traitement local des tuberculoses...–Google Scholar [Internet]. [cited 2020 Dec 7]. Available from: https://scholar.google.com/scholar_lookup?journal=Acta+Chir+Scand&title=Sur+le+meilleur+traitement+local+des+tuberculoses+des+os,+articulations+et+ganglions+lymphatiques&author=T+Calot&volume=67&publication_year=1930&pages=206-226&

  14. Albee F. The Bone-graft operation for tuberculosis of the spine: twenty years’ experience. JAMA. 1930;94(19):1467–71.

    Article  Google Scholar 

  15. Iseman MD. Tuberculosis therapy: past, present and future. Eur Respir J. 2002 Jul 1;20(36 suppl):87S–94s.

    Article  Google Scholar 

  16. Group BMJP. Various combinations of isoniazid with streptomycin or with P.A.S. in the treatment of pulmonary tuberculosis: seventh report to the medical research council. Br Med J. 1955 Feb 19;1(4911):435–45.

    Article  Google Scholar 

  17. Ethambutol in the Initial Treatment of Pulmonary Tuberculosis | U. S. Public Health Service Tuberculosis Therapy Trials1,2 | American Review of Respiratory Disease [Internet]. [cited 2020 Dec 9]. Available from: https://www.atsjournals.org/doi/abs/10.1164/arrd.1973.107.2.177

  18. Controlled clinical trial of four 6-month regimens of chemotherapy for pulmonary tuberculosis. Second report. Second East African/British Medical Research Council Study. Am Rev Respir Dis. 1976 Sep;114(3):471–5.

    Google Scholar 

  19. Konstam PG, Blesovsky A. The ambulant treatment of spinal tuberculosis. BJS Br J Surg. 1962;50(219):26–38.

    Article  CAS  Google Scholar 

  20. Infections and Tumors of the Spine- ClinicalKey [Internet]. [cited 2020 Dec 7]. Available from: https://www.clinicalkey.com/?scrollTo=%23hl0001181#!/content/book/3-s2.0-B9780323374620000422?scrollTo=%23hl0000860

  21. Hodgson AR, Stock FE. Anterior spine fusion for the treatment of tuberculosis of the spine: the operative findings and results of treatment in the first one hundred cases. JBJS. 1960 Mar;42(2):295–310.

    Article  Google Scholar 

  22. Wilkinson MC. Chemotherapy of tuberculosis of bones and joints. J Bone Joint Surg Br. 1954 Feb 1;36-B(1):23–35.

    Article  CAS  PubMed  Google Scholar 

  23. Friedman B. Chemotherapy of tuberculosis of the spine. JBJS. 1966 Apr;48(3):451–74.

    Article  CAS  Google Scholar 

  24. Tuli SM. Results of treatment of spinal tuberculosis by ‘middle-path’ regime. J Bone Joint Surg Br. 1975 Feb;57(1):13–23.

    Article  CAS  PubMed  Google Scholar 

  25. Sandher DS, Al-Jibury M, Paton RW, Ormerod LP. Bone and joint tuberculosis: cases in Blackburn between 1988 and 2005. J Bone Joint Surg Br. 2007 Oct;89(10):1379–81.

    Article  CAS  PubMed  Google Scholar 

  26. Tuli SM. Tuberculosis of the spine: a historical review. Clin Orthop. 2007 Jul;460:29–38.

    Article  CAS  PubMed  Google Scholar 

  27. A 15-year assessment of controlled trials of the management of tuberculosis of the spine in Korea and Hong Kong. Thirteenth report of the medical research council working party on tuberculosis of the spine. J Bone Joint Surg Br. 1998 May;80(3):456–62.

    Article  Google Scholar 

  28. Five-year assessment of controlled trials of short-course chemotherapy regimens of 6, 9 or 18 months’ duration for spinal tuberculosis in patients ambulatory from the start or undergoing radical surgery. Fourteenth report of the Medical Research Council Working Party on Tuberculosis of the Spine. Int Orthop. 1999;23(2):73–81.

    Google Scholar 

  29. A controlled trial of six-month and nine-month regimens of chemotherapy in patients undergoing radical surgery for tuberculosis of the spine in Hong Kong. Tenth report of the medical research council working party on tuberculosis of the spine. Tubercle. 1986 Dec;67(4):243–59.

    Google Scholar 

  30. Five-year assessments of controlled trials of ambulatory treatment, debridement and anterior spinal fusion in the management of tuberculosis of the spine. Studies in Bulawayo (Rhodesia) and in Hong Kong. Sixth report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg Br 1978;60-B(2):163–77.

    Google Scholar 

  31. A controlled trial of anterior spinal fusion and débridement in the surgical management of tuberculosis of the spine in patients on standard chemotherapy: a study in two centres in South Africa. Seventh report of the medical research council working party on tuberculosis of the spine. Tubercle. 1978 Jun;59(2):79–105.

    Google Scholar 

  32. Dietze DD, Fessler RG, Jacob RP. Primary reconstruction for spinal infections. J Neurosurg. 1997 Jun;86(6):981–9.

    Article  PubMed  Google Scholar 

  33. Kirkaldy-Willis WH, Thomas TG. Anterior approaches in the diagnosis and treatment of infections of the vertebral bodies. JBJS. 1965 Jan;47(1):87–110.

    Article  CAS  Google Scholar 

  34. Anterior Fusion of the spine for infective lesions in adults | The Bone & Joint Journal [Internet]. [cited 2020 Dec 9]. Available from: https://online.boneandjoint.org.uk/doi/abs/10.1302/0301-620X.55B4.715

  35. Hsu LC, Leong JC. Tuberculosis of the lower cervical spine (C2 to C7). A report on 40 cases. J Bone Joint Surg Br. 1984 Jan;66(1):1–5.

    Article  CAS  PubMed  Google Scholar 

  36. Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958 Jun;40-A(3):607–24.

    Article  CAS  PubMed  Google Scholar 

  37. Khoo LT, Mikawa K, Fessler RG. A surgical revisitation of Pott distemper of the spine. Spine J. 2003 Mar 1;3(2):130–45.

    Article  PubMed  Google Scholar 

  38. Korkusuz F, Islam C, Korkusuz Z. Prevention of postoperative late kyphosis in Pott’s disease by anterior decompression and intervertebral grafting. World J Surg. 1997 Jul;21(5):524–8.

    Article  CAS  PubMed  Google Scholar 

  39. Yin XH, Liu ZK, Hao D. The reasons and clinical treatments of postoperative relapse of Pott’s disease. Medicine (Baltimore) [Internet]. 2018 Sep 28 [cited 2020 Dec 9];97(39). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6181606/

  40. Oga M, Arizono T, Takasita M, Sugioka Y. Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study. Spine. 1993 Oct 1;18(13):1890–4.

    Article  CAS  PubMed  Google Scholar 

  41. Yilmaz C, Selek HY, Gürkan I, Erdemli B, Korkusuz Z. Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Joint Surg Am. 1999 Sep;81(9):1261–7.

    Article  CAS  PubMed  Google Scholar 

  42. Ha K-Y, Chung Y-G, Ryoo S-J. Adherence and biofilm formation of staphylococcus epidermidis and mycobacterium tuberculosis on various spinal implants. Spine. 2005 Jan 1;30(1):38–43.

    Article  PubMed  Google Scholar 

  43. Rajasekaran S. Buckling collapse of the spine in childhood spinal tuberculosis. Clin Orthop. 2007 Jul;460:86–92.

    Article  CAS  PubMed  Google Scholar 

  44. Rajasekaran S. The natural history of post-tubercular kyphosis in children. Radiological signs which predict late increase in deformity. J Bone Joint Surg Br. 2001 Sep;83(7):954–62.

    Article  CAS  PubMed  Google Scholar 

  45. Rajasekaran S, Kanna RM, Shetty AP. History of spine surgery for tuberculous spondylodiscitis. Unfallchirurg. 2015 Dec 1;118(1):19–27.

    Article  PubMed  Google Scholar 

  46. Schulitz KP, Kothe R, Leong JC, Wehling P. Growth changes of solidly fused kyphotic bloc after surgery for tuberculosis. Comparison of four procedures. Spine. 1997 May 15;22(10):1150–5.

    Article  CAS  PubMed  Google Scholar 

  47. Kim N-H, Lee H-M, Suh J-S. Magnetic Resonance Imaging for the Diagnosis of Tuberculous Spondylitis. Spine. 1994 Nov;19(21):2451–5.

    Article  CAS  PubMed  Google Scholar 

  48. Kim BJ, Ko HS, Lim Y, Seo JG, Zoo SK, Jeon TH. The clinical study of the tuberculous spondylitis. J Korean Orthop Assoc. 1993;28:2221–32.

    Article  Google Scholar 

  49. Lee EY, Hahn MS. A study of influences of the anterior intervertebral fusion upon the correctability of kyphosis in the tuberculous spondylitis. J Korean Orthop Assoc. 1968;3:31–40.

    Article  Google Scholar 

  50. Rajasekaran S, Soundarapandian S. Progression of the kyphosis in tuberculosis of the spine treated by anterior arthrodesis. J Bone Jt Surg AM. 1987;69:503–9.

    Article  CAS  Google Scholar 

  51. Moon MS, Woo YK, Lee KS, Ha KY, Kim SS, Sun DH. Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spines. Spine. 1995 Sep 1;20(17):1910–6.

    Article  CAS  PubMed  Google Scholar 

  52. Cotrel Y, Dubousset J, Guillaumat M. New universal instrumentation in spinal surgery. Clin Orthop. 1980;227:10–23.

    Google Scholar 

  53. Güven O, Kumano K, Yalçin S, Karahan M, Tsuji S. A single stage posterior approach and rigid fixation for preventing kyphosis in the treatment of spinal tuberculosis. Spine. 1994 May 1;19(9):1039–43.

    Article  PubMed  Google Scholar 

  54. Zhang HQ, Li JS, Zhao SS, Shao YX, Liu SH, Gao Q, et al. Surgical management for thoracic spinal tuberculosis in the elderly: posterior only versus combined posterior and anterior approaches. Arch Orthop Trauma Surg. 2012 Dec 1;132(12):1717–23.

    Article  PubMed  Google Scholar 

  55. Liu Z, Zhang P, Li W, Xu Z, Wang X. Posterior-only vs. combined posterior-anterior approaches in treating lumbar and lumbosacral spinal tuberculosis: a retrospective study with minimum 7-year follow-up. J Orthop Surg. 2020 Mar 10;15(1):99.

    Article  Google Scholar 

  56. Wu W, Lyu J, Liu X, Luo F, Hou T, Zhou Q, et al. Surgical treatment of thoracic spinal tuberculosis: a multicenter retrospective study. World Neurosurg. 2018 Feb 1;(110):e842–50.

    Google Scholar 

  57. Kurz SG, Furin JJ, Bark CM. Drug resistant tuberculosis: challenges and progress. Infect Dis Clin N Am. 2016 Jun;30(2):509–22.

    Article  Google Scholar 

  58. Oxford–AstraZeneca COVID-19 vaccine efficacy–The Lancet [Internet]. [cited 2021 Feb 14]. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32623-4/fulltext?fbclid=IwAR39cr4iOmVyctpuoZ5JdxytsnRdYm6lwsO24Fhb3refju1PcHLC7bTitSs

  59. Andersen P, Doherty TM. The success and failure of BCG–implications for a novel tuberculosis vaccine. Nat Rev Microbiol. 2005 Aug;3(8):656–62.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK

    Dhiraj Sharma & Amarjit Singh Rai

Authors
  1. Dhiraj Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amarjit Singh Rai
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India

    Sarvdeep Singh Dhatt

  2. Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India

    Vishal Kumar

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sharma, D., Rai, A.S. (2022). History of Tuberculosis Spine (Post-ATT Era). In: Dhatt, S.S., Kumar, V. (eds) Tuberculosis of the Spine. Springer, Singapore. https://doi.org/10.1007/978-981-16-9495-0_2

Download citation

  • DOI: https://doi.org/10.1007/978-981-16-9495-0_2

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-16-9494-3

  • Online ISBN: 978-981-16-9495-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation