Child's Nervous System

, Volume 34, Issue 10, pp 1937–1945 | Cite as

The spectrum of tuberculosis of the spine in pediatric age group: a review

  • Sandip ChatterjeeEmail author
  • Aditya Banta
Special Annual Issue



Pediatric spinal tuberculosis is characterized by rapid bone destruction and carries the risk of rapid onset neurological deficits and severe deformity of the spine. Behavior of spinal deformity over time is affected by growth of spine. Owing to this dynamic behavior of pediatric spinal tuberculosis both in active phase and in healed phase, it presents with challenges which are quite different from adults with caries spine. A clinician must have high index of suspicion for accurate and early diagnosis of spinal tuberculosis in the pediatric population and should also have a thorough knowledge of differences in natural history between adult and pediatric spinal tuberculosis.


This is based on the senior author’s experience of dealing with tuberculosis of the spine in children over the last two decades. Recent advances in field of rapid diagnosis of tuberculosis based on nuclear material-related diagnostic tests have further improved the management of tuberculosis. At the same time, the basic treatment principles remain the same. However, the threshold for surgical vs conservative treatment have subtle differences when compared to adult population. The importance of long-term follow-up after treatment must be appreciated.


Tuberculosis in the spine in children needs early attention. Prompting to diagnostic and medical therapy measures can avoid neurological sequellae and delayed deformity.


Pediatric spinal tuberculosis Caries spine Skeletal system 


Compliance with ethical standards

Conflict of interest

Neither author has any conflict of interests.


  1. 1.
    World Health Organization. Global tuberculosis report 2016Google Scholar
  2. 2.
    Maltezou HC, Spyridis P, Kafetzis DA (2000) Extra-pulmonary tuberculosis in children. Arch Dis Child 83(4):342–346CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Moon MS, Kim SS, Lee BJ, Moon JL (2012) Spinal tuberculosis in children: retrospective analysis of 124 patients. Indian J Orthop 46:150–158CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    (1973) A controlled trial of ambulant out-patient treatment and in-patient rest in bed in the management of tuberculosis of the spine in young Korean patients on standard chemotherapy a study in Masan. Korea. First report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg Br 55:678–697Google Scholar
  5. 5.
    (1974) A controlled trial of anterior spinal fusion and debridement in the surgical management of tuberculosis of the spine in patients on standard chemotherapy: a study in Hong Kong. Br J Surg 61:853–866Google Scholar
  6. 6.
    (1982) A 10-year assessment of a controlled trial comparing debridement and anterior spinal fusion in the management of tuberculosis of the spine in patients on standard chemotherapy in Hong Kong. Eighth Report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg Br 64:393–398Google Scholar
  7. 7.
    Basu S (2012) Spinal injuries in children. Front Neurol 3:96CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Jain AK, Sreenivasan R, Mukunth R, Dhammi IK (2014) Tubercular spondylitis in children. Indian J Orthop 48(2):136–144CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Dimeglio A, Canavese F (2012) The growing spine: how spinal deformities influence normal spine and thoracic cage growth. Eur Spine J 21(1):64–70CrossRefPubMedGoogle Scholar
  10. 10.
    Teo HE, Peh WC (2004) Skeletal tuberculosis in children. Pediatr Radiol 34(11):853–860CrossRefPubMedGoogle Scholar
  11. 11.
    Tyagi R (2016) Spinal infections in children: a review. J Orthop 13(4):254–258CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    De Vuyst D, Vanhoenacker F, Gielen J et al (2003) Imaging features of musculoskeletal tuberculosis. Eur Radiol 13:1809–1819CrossRefPubMedGoogle Scholar
  13. 13.
    Tuli SM (2016) Tuberculosis of the skeletal system. JP Medical LtdGoogle Scholar
  14. 14.
    Hoffman EB, Crosier JH, Cremin BJ (1993) Imaging in children with spinal tuberculosis—a comparison of radiography, computed tomography and magnetic resonance imaging. JBJS 75B:233–239Google Scholar
  15. 15.
    Jain AK, Agarwal AN, Mehrotra G (1999) Correlation of canal encroachment with neurological deficit in tuberculosis of spine. Int Orthop 23(2):85–86CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Jain AK, Kumar J (2013) Tuberculosis of spine: neurological deficit. Eur Spine J 22(4):624–633CrossRefPubMedGoogle Scholar
  17. 17.
    Jain AK, Sinha S (2005) Evaluation of paraplegia grading systems in tuberculosis of the spine. Spinal Cord 43(6):375–380CrossRefPubMedGoogle Scholar
  18. 18.
    Govender S, Ramnarain A, Danaviah S (2007) Cervical spine tuberculosis in children. Clin Orthop Relat Res 460:78–85CrossRefPubMedGoogle Scholar
  19. 19.
    Jain AK, Dhammi IK, Jain S, Mishra P (2010 Apr) Kyphosis in spinal tuberculosis–prevention and correction. Indian J Orthop 44(2):127–136CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Rajasekaran S (2001) The natural history of post-tubercular kyphosis in children: radiological signs which predict late increase in deformity. Bone Joint J 83(7):954–962CrossRefGoogle Scholar
  21. 21.
    Cohn DL, O'Brien RJ, Geiter LJ, Rockville MD, Gordin FM, Hershfield E, Horsburgh CR Jr, Jereb JA, Jordan TJ, Kaplan JE, Nolan CM (2000) Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 161(4):221–247Google Scholar
  22. 22.
    Horsburgh CR Jr (2004) Priorities for the treatment of latent tuberculosis infection in the United States. N Engl J Med 350(20):2060–2067CrossRefPubMedGoogle Scholar
  23. 23.
    Hoskyns W (2003) Paediatric tuberculosis. Postgrad Med J 79(931):272–278CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Walls T, Shingadia D (2004) Global epidemiology of paediatric tuberculosis. J Infect 48(1):13–22CrossRefPubMedGoogle Scholar
  25. 25.
    International Union Against Tuberculosis Committee on Prophylaxis (1982) Efficacy of various durations of isoniazid preventive therapy for tuberculosis: five years of follow-up in the IUAT trial. Bull World Health Organ 60(4):555PubMedCentralGoogle Scholar
  26. 26.
    Lewinsohn DM, Leonard MK, LoBue PA, Cohn DL, Daley CL, Desmond E, Keane J, Lewinsohn DA, Loeffler AM, Mazurek GH, O’Brien RJ (2017) Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis 64(2):e1–e33 5CrossRefPubMedGoogle Scholar
  27. 27.
    Malakmadze N, González IM, Oemig T, Isiadinso I, Rembert D, McCauley MM, Wand P, Diem L, Cowan L, Palumbo GJ, Fraser M (2005) Unsuspected recent transmission of tuberculosis among high-risk groups: implications of universal tuberculosis genotyping in its detection. Clin Infect Dis 40(3):366–373CrossRefPubMedGoogle Scholar
  28. 28.
    Kimerling ME, Benjamin WH, Lok KH, Curtis G, Dunlap NE (1998) Restriction fragment length polymorphism screening of Mycobacterium tuberculosis isolates: population surveillance for targeting disease transmission in a community. Int J Tuberc Lung Dis 2(8):655–662PubMedGoogle Scholar
  29. 29.
    Behr MA, Small PM (1997) Molecular fingerprinting of Mycobacterium tuberculosis: how can it help the clinician? Clin Infect Dis 25(4):806–810CrossRefPubMedGoogle Scholar
  30. 30.
    Moore SL, Rafi M (2001) Imaging of musculoskeletal and spinal tuberculosis. Radiol Clin N Am 39:329–342CrossRefPubMedGoogle Scholar
  31. 31.
    Gard RK, Somvanshi DS (2011) Spinal tuberculosis: a review. J Spinal Cord Med 34:440–454CrossRefGoogle Scholar
  32. 32.
    Guo LX, Ma YZ, Chen X, Bao D, Luo XB (2010) Clinical study of short course chemotherapy in spinal tuberculosis. Zhogguo Gu Shang 23:491–494Google Scholar
  33. 33.
    Kotil K, Alan MS (2007) Medical management of Pott disease in thoracic and lumbar spine: a prospective clinical study. J Neurosurg Spine 6:222–228CrossRefPubMedGoogle Scholar
  34. 34.
    Parthasarthy R, Sriram K, Santha T (1999) Short course chemotherapy for tuberculosis of spine—a comparison between treatment and radical surgery. J Bone Joint Surg Br 81:464–471CrossRefGoogle Scholar
  35. 35.
    Mak KC, Cheung KM (2013) Surgical treatment of acute TB spondylitis: indications and outcomes. Eur Spine J 22(4):603–611CrossRefPubMedGoogle Scholar
  36. 36.
    Tuli SM (1975) Results of treatment of spinal tuberculosis by “middle-path” regime. J Boone Joint Surg (Br) 57B:13–23CrossRefGoogle Scholar
  37. 37.
    Kumar R, Srivastava AK, Tiwari RK (2011) Surgical management of Pott’s disease of the spine in pediatric patients: a single surgeon’s experience of 8 years in a tertiary care center. J PediatrNeurosci 6(Suppl 1):S101–S108Google Scholar
  38. 38.
    Chatterjee S, Basu S (2003) Trans sternal decompression of postlaminectomy caries of the upper dorsal spine. Br J Neurosurg 17(3):270–271CrossRefPubMedGoogle Scholar
  39. 39.
    Jain AK, Maheshwari AV, Jena S (2007) Kyphus correction in spinal tuberculosis. Clin Orthop Relat Res 460:117–123CrossRefPubMedGoogle Scholar
  40. 40.
    Laheri VJ, Badhe NP, Dewnany GT (2001) Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine. Spinal Cord 39:429–436CrossRefPubMedGoogle Scholar
  41. 41.
    Bezer M, Kucukdurmaz F, Guven O (2007) Transpedicular decancellation osteotomy in the treatment of posttuberculous kyphosis. J Spinal Disord Tech 20:209–215CrossRefPubMedGoogle Scholar
  42. 42.
    Moon MS, Woo YK, Lee KS, Ha KY, Kim SS, Sun DH (1995) Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spines. Spine 20:1910–1916CrossRefPubMedGoogle Scholar
  43. 43.
    Moon MS (1999) Tuberculosis of the spine-controversies and a new challenge. Spine 22:1791–1797CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Neurosciences DivisionPark ClinicKolkataIndia

Personalised recommendations