The epidemiology of spinal tuberculosis in the United States: an analysis of 2002–2011 data

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OBJECTIVE

The aim of this study was to investigate the incidence of spinal tuberculosis (TB) in the US between 2002 and 2011.

METHODS

The Nationwide Inpatient Sample database from 2002 to 2011 was used to identify patients with a discharge diagnosis of TB and spinal TB. Demographic and hospital data were obtained for all admissions, and included age, sex, race, comorbid conditions, insurance status, hospital location, hospital teaching status, and hospital region. The incidence rate of spinal TB adjusted for population growth was calculated after application of discharge weights.

RESULTS

A total of 75,858 patients with a diagnosis of TB were identified, of whom 2789 had a diagnosis of spinal TB (3.7%); this represents an average of 278.9 cases per year between 2002 and 2011. The incidence of spinal TB decreased significantly—from 0.07 cases per 100,000 persons in 2002 to 0.05 cases per 100,000 in 2011 (p < 0.001), corresponding to 1 case per 2 million persons in the latter year. The median age for patients with spinal TB was 51 years, and 61% were male; 11.6% were patients with diabetes, 11.4% reported recent weight loss, and 8.1% presented with paralysis. There were 619 patients who underwent spinal surgery for TB, with the most common location being the thoracolumbar spine (61.9% of cases); 50% of patients had instrumentation of 3 or more spinal segments.

CONCLUSIONS

During the examined 10-year period, the incidence of spinal TB was found to significantly decrease over time in the US, reaching a rate of 1 case per 2 million persons in 2011. However, the absolute reduction was relatively small, suggesting that although it is uncommon, spinal TB remains a public health concern and most commonly affects male patients approximately 50 years of age. Approximately 20% of patients with spinal TB underwent surgery, most commonly in the thoracolumbar spine.

ABBREVIATIONSICD-9 = International Classification of Diseases, 9th Revision; LOS = length of stay; NIS = Nationwide Inpatient Sample; TB = tuberculosis.

Abstract

OBJECTIVE

The aim of this study was to investigate the incidence of spinal tuberculosis (TB) in the US between 2002 and 2011.

METHODS

The Nationwide Inpatient Sample database from 2002 to 2011 was used to identify patients with a discharge diagnosis of TB and spinal TB. Demographic and hospital data were obtained for all admissions, and included age, sex, race, comorbid conditions, insurance status, hospital location, hospital teaching status, and hospital region. The incidence rate of spinal TB adjusted for population growth was calculated after application of discharge weights.

RESULTS

A total of 75,858 patients with a diagnosis of TB were identified, of whom 2789 had a diagnosis of spinal TB (3.7%); this represents an average of 278.9 cases per year between 2002 and 2011. The incidence of spinal TB decreased significantly—from 0.07 cases per 100,000 persons in 2002 to 0.05 cases per 100,000 in 2011 (p < 0.001), corresponding to 1 case per 2 million persons in the latter year. The median age for patients with spinal TB was 51 years, and 61% were male; 11.6% were patients with diabetes, 11.4% reported recent weight loss, and 8.1% presented with paralysis. There were 619 patients who underwent spinal surgery for TB, with the most common location being the thoracolumbar spine (61.9% of cases); 50% of patients had instrumentation of 3 or more spinal segments.

CONCLUSIONS

During the examined 10-year period, the incidence of spinal TB was found to significantly decrease over time in the US, reaching a rate of 1 case per 2 million persons in 2011. However, the absolute reduction was relatively small, suggesting that although it is uncommon, spinal TB remains a public health concern and most commonly affects male patients approximately 50 years of age. Approximately 20% of patients with spinal TB underwent surgery, most commonly in the thoracolumbar spine.

Spinal tuberculosis (TB) is a known cause of spinal deformity and paraplegia. First described in the modern era by English surgeon Percival Pott in 1779 (i.e., Pott's disease),20 it is currently regarded as a disease affecting people in the developing world.7 Nevertheless, TB remains a problem in developed regions such as Europe and the US.6,16,25 In 2014 alone, a total of 9421 new cases of TB were reported in the US, corresponding to an incidence of 2.96 cases per 100,000 persons.5

Pott was the first to recognize the link between TB, kyphosis, and paraplegia.12 Whereas spinal TB affects mostly children in developing nations, it is a disease of the elderly in the developed world.7 Pott's disease develops after hematogenous spread of Mycobacterium tuberculosis from a primary site (typically the lungs), which leads to destruction of the intervertebral disc and vertebral body.11 This results in a pathological compression fracture, vertebral wedging, and kyphoscoliosis, which in turn may lead to neurological deficits due to spinal cord compression.2,14,17

Despite multiple epidemiological studies examining TB, there are limited data on the prevalence of Pott's disease in the US.9,13 The aim of this study is to investigate the incidence of spinal TB in the American population between 2002 and 2011, using a large nationwide database.

Methods

Study Design

This epidemiological study used the Nationwide Inpatient Sample (NIS) database records of patients treated between 2002 and 2011. Developed by the Healthcare Cost and Utilization Project, the NIS is the largest inpatient database in the US, containing hospital admission information from a 20% sample of community hospitals across the country. This 20% sample corresponds to more than 8 million hospital stays annually and contains diagnostic and procedure data in the form of International Classification of Diseases, 9th Revision (ICD-9) codes.

Patient Sample and Inclusion Criteria

All patients with a diagnosis of “tuberculosis” were identified using the Clinical Classifications Software code #1. Patients with spinal TB were then identified via use of ICD-9 codes 015.00, 015.01, 015.02, 015.03, 015.04, 015.05, and 015.06. Patients who underwent spinal fusion were identified via ICD-9 procedural codes 81.00–81.09.

Recorded Variables

Documented admission information included the following: patient age; sex; race; comorbid conditions; primary payer (insurance); hospital region (Northeast, Midwest or North Central, South, or West); hospital teaching status; hospital location (urban vs rural); in-hospital mortality rate; and length of stay (LOS). For patients who underwent spinal surgery, the following complications were recorded: neurological complications; iatrogenic stroke; respiratory complications (including respiratory failure); pulmonary embolism; deep venous thrombosis; myocardial infarction; acute kidney injury; urinary tract infection; Clostridium difficile; paralytic ileus; other gastrointestinal complication; surgical site infection; meningitis; pneumonia; and incidental durotomy. Hospital charges (excluding professional fees) were also recorded and reported in 2016 US dollars.

Statistical Methods

National estimates for spinal TB cases were calculated after application of discharge weights supplied by the NIS. Given that this database is a 20% sample, roughly a 5-fold multiplication will give the total number of estimated cases in the US per year. US population data for each year were obtained from the website of the US Census Bureau (http://www.census.gov/popest/data/historical/index.html). Incidences for any given year were adjusted for population growth by dividing the estimate of each diagnosis (from the NIS) by the total population estimate from the US Census Bureau.4 A simple linear regression was done to analyze trends over time. Statistical analyses were performed in STATA 12 SE (StataCorp). A probability value < 0.05 was considered statistically significant.

Results

Between 2002 and 2011, a total of 75,858 patients with a diagnosis of TB were identified, of whom 2789 had a diagnosis of spinal TB (3.7%). The average annualized rate of spinal TB was 278.9 cases per year. During the 10-year period examined, the incidence of spinal TB decreased significantly, from 0.07 cases per 100,000 persons in 2002 to 0.05 per 100,000 in 2011 (Fig. 1). In 2011, this incidence corresponded to 1 case per every 2 million persons.

FIG. 1.
FIG. 1.

Graph showing the population growth–adjusted incidence rate of patients with a discharge diagnosis of spinal TB in the US from 2002 to 2011. After a peak in 2003, the incidence was found to decrease significantly over time (p < 0.001). Figure is available in color online only.

The proportion of spinal TB cases among all TB cases was 4.1%, 5.6%, 3.3%, 3.8%, 2.6%, 3.7%, 4.0%, 4.0%, 3.0%, and 2.6% yearly between 2002 and 2011 (Fig. 2). A summary of spinal TB cases is shown in Table 1. The median age of patients was 51 years, and 61% were male. There was an almost equal proportion of Caucasian (24.0%), African American (23.8%), and Hispanic patients (23.2%), and a smaller proportion of Asian/Pacific Islanders (18.8%) and others (10.2%). The 5 most common comorbid conditions were hypertension (28.6%), diabetes (11.6%), malnutrition (11.6%), weight loss (11.4%), and paralysis (8.1%); 4.0% of patients were HIV positive. More than one-fourth (26.2%) of patients had private insurance, 25.8% had Medicare, 24.4% had Medicaid, 12.2% had another form of insurance, and 11.4% were categorized as self-pay.

FIG. 2.
FIG. 2.

Bar graph showing the proportion of patients with spinal TB among all TB cases. The proportion was found to decrease significantly, from 4.1% in 2002 to 2.6% in 2011 (p < 0.001). Figure is available in color online only.

TABLE 1.

Summary of characteristics in 2789 patients with a diagnosis of spinal TB

ParameterValue
No. of cases2789
Median age in yrs (IQR)51 (35–65)
Age >65 yrs (%)24.4
Sex (%)
  Female39.0
  Male61.0
Race (%)
  Caucasian24.0
  African American23.8
  Hispanic23.2
  Asian or Pacific Islander18.8
  Other10.2
Comorbidities (%)
  Alcohol abuse3.0
  Chronic lung disease7.7
  Diabetes11.6
  Drug abuse5.5
  Hypertension28.6
  Liver disease4.9
  Obesity2.8
  Renal failure5.6
  Paralysis8.1
  Weight loss11.4
  HIV positive4.0
  Malnutrition11.6
Insurance status (%)
  Medicare25.8
  Medicaid24.4
  Private insurance26.2
  Self-pay11.4
  Other12.2
Hospital region (%)
  Northeast22.6
  Midwest or North Central10.1
  South39.9
  West27.4
Teaching hospital (%)76.8
Urban hospital (%)97.7
In-hospital mortality (%)1.9
Median LOS in days (IQR)10 (6–19)

IQR = interquartile range.

The most common hospital region was the South (39.9%), followed by the West (27.4%), the Northeast (22.6%), and the Midwest or North Central (10.1%). A majority of patients were admitted to urban hospitals (97.7%) with teaching status (76.8%). The in-hospital mortality rate was 1.9%, and the median LOS was 10 days.

There were 619 patients who underwent spinal surgery for TB (22.2% of spinal TB cases) (Table 2), with a median age at surgery of 52 years; 55.6% were male. The most common location was the thoracolumbar spine (61.9% of cases), and 50% of patients had instrumentation of 3 or more spinal segments. The surgical approach was posterior alone in 38.9% of cases, anterior alone in 26.6%, and combined in 34.5%. The mortality rate was 3.2%, and the median LOS was 16 days. The percentage of patients who developed at least 1 in-hospital complication was 38.8%. The proportion of patients with spinal TB who required surgery was 23.1%, 20.0%, 13.6%, 16.9%, 23.4%, 25.4%, 32.2%, 16.4%, 20.5%, and 18.9% between 2002 and 2011 (p = 0.426). The average adjusted hospital charges for patients who required surgery were $223,780 ± $168,361, versus $55,363 ± $72,998 for patients with spinal TB who did not require surgery (p < 0.001).

TABLE 2.

Summary characteristics of 619 patients who underwent surgery for spinal TB between 2002 and 2011

ParameterValue
No. of cases619
Median age in yrs (IQR)52 (35–66)
Age >65 yrs (%)26.2
Sex (%)
  Female44.4
  Male55.6
Surgery location (%)
  Cervical11.1
  Thoracolumbar61.9
  Lumbosacral27.0
Approach (%)
  Posterior only38.9
  Anterior only26.6
  Combined34.5
No. of instrumented levels (%)
  1–250.0
  3–742.0
  ≥88.0
Complication rate (%)38.8
In-hospital mortality (%)3.2
Median LOS in days (IQR)16 (10–24)

Discussion

Although the first modern description of spinal TB was published in 1779, the first evidence of this disease dates to a skeleton from approximately 5000 bc.12 Nowadays, Pott's disease mostly affects children and young adults in developing countries,17,18 and may cause severe spinal deformity and associated paraparesis secondary to cord compression (Fig. 3). Nonetheless, spinal TB is still seen in vulnerable populations in the developed world, including Europe and the US. The aim of this study was to investigate the incidence of Pott's disease in America, and although we found a statistically significant decrease between 2002 and 2011, the absolute decrease was relatively small (from 0.07 per 100,000 persons to 0.05 per 100,000).

FIG. 3.
FIG. 3.

A 21-year-old woman, an immigrant, presented to our institution with a severe kyphotic deformity of the thoracic spine and mild paraparesis secondary to TB. Left: Preoperative CT scan of the thoracic spine showing destruction of T-7, T-8, and T-9, with severe focal kyphosis. Right: Preoperative T2-weighted MR image showing focal kyphotic deformity and spinal cord compression.

In 2002, there were an estimated total of 188 cases of spinal TB (0.07 per 100,000 persons), which peaked to 457 in 2003 (0.16 per 100,000 persons). Afterward, the total number of cases gradually decreased, reaching 155 cases in 2011, which corresponds to 0.05 per 100,000, or 1 per 2 million persons. Patients with spinal TB were on average 51 years of age, and 61% were male. Commensurate with our findings, Brashear and Rendelman also reported an average age of 51 years in a series of patients with spinal TB from the southern US.3 Schlesinger et al. examined 12 patients with Pott's disease from a New Jersey hospital (Northeast US), finding a mean age of 40 years and male predominance (58%).22

The prevalence of HIV positivity was 4.0% in the present study, and 5.5% of patients had a history of drug abuse. Similar to these findings, Fuentes Ferrer et al. performed a systematic review of spinal TB case series, finding a median prevalence of HIV of 7.5%.10 On the other hand, more than one-tenth of patients in our study presented with diabetes, malnutrition, and/or weight loss, all of which have been associated with spinal TB.10,15,23

Interestingly, the most common hospital regions were the southern US in almost 40% of cases, followed by the western US in 27.4%. Similar to these findings, the official report from the Centers for Disease Control and Prevention found a higher than average incidence for states such as Texas, Florida, Georgia, California, and Nevada.5 These aforementioned states had an incidence of > 3 cases per 100,000 persons, which was higher than the national average of ≤ 3 cases per 100,000. Although there is no single explanation for these findings, contributing factors to the observed higher incidence in these states include a larger proportion of patients who were foreign born and higher rates of homelessness, among others.1

In the present study, 22.2% of spinal TB cases required surgery, with the most common location being the thoracolumbar spine in 61.9% of cases, followed by the lumbosacral spine in 27.0%, and the cervical spine in 11.1%. With the availability of systemic antituberculous therapy, surgery for spinal TB is reserved for patients with neurological deficits, instability due to kyphoscoliotic deformity, drug-resistant TB, or those in whom there is a high risk of paralysis.21 In a randomized controlled trial performed in the United Kingdom, researchers randomized patients with spinal TB to 1 of 3 groups: A) surgery plus 6 months of isoniazid plus rifampicin; B) isoniazid plus rifampicin for 6 months; or C) isoniazid plus rifampicin for 9 months.19 The authors found rates of “favorable status” in 90%, 94%, and 99% of patients in Groups A, B, and C, respectively. Nevertheless, patients younger than 15 years of age with kyphotic deformity greater than 30° did not experience as much improvement with medical therapy alone. Surgical techniques include posterior decompression and stabilization, anterior decompression and stabilization, and combined approaches (either posterior-anterior or anterior-posterior) with stabilization (Fig. 4).21

FIG. 4.
FIG. 4.

The same patient depicted in Fig. 3 underwent a combined anterolateral-posterior approach. The first stage consisted of a right-sided thoracotomy, resection of rib, and corpectomy of T-7, T-8, and T-9. This was followed by placement of a distractible cage, plate, and screws, reduction of kyphosis, and arthrodesis using allograft and local autograft from T-6 to T-10. This was followed by drainage of abscess. The second stage consisted of pedicle screw instrumentation from T-3 to T-12 and arthrodesis performed using locally obtained autograft, allograft, and demineralized bone matrix. Left: Postoperative CT image showing the distractible cage between T-6 and T-10. Right: Postoperative radiograph showing anterior and posterior reconstruction.

Although spinal TB is considered predominantly a disease affecting people in the developing world, the findings in the present study suggest that it is still seen in the US. The incidence of Pott's disease has slightly decreased, and the 2011 estimate was of 1 case per 2 million. Patients at the highest risk for TB (immunocompromised, malnourished, living in poverty, with a history of traveling to high-prevalence areas, and others) who pre sent with back pain should be evaluated for the possibility of Pott's disease.

Study Limitations

This study has several limitations. Although the NIS database has been used in multiple studies examining the epidemiology and trends of various spinal disorders,4,8,24 its administrative nature carries a risk of coding bias. Given that it is an inpatient database, spinal TB cases treated in an outpatient setting are not captured, and thus the true incidence of spinal TB may be higher. The lack of data on functional status, degrees of kyphosis, or long-term outcome is also an important limitation. Nevertheless, this is one of the first studies to report the incidence of Pott's disease in a developed country, and the use of such a large database allows for adequate estimation of the incidence of rare conditions.

Conclusions

In this study of a nationwide database, the incidence of spinal TB was found to decrease significantly over time in the US, reaching a rate of 1 case per 2 million persons in 2011. However, the absolute reduction was relatively small, suggesting that although it is uncommon, spinal TB remains a public health concern most commonly affecting male patients approximately 50 years of age. Of all spinal TB cases, approximately 20% required surgery—most commonly in the thoracolumbar spine.

References

  • 1

    Alami NNYuen CMMiramontes RPratt RPrice SFNavin TR: Trends in tuberculosis—United States, 2013. MMWR Morb Moral Wkly Rep 63:2292332014

  • 2

    Boachie-Adjei OPapadopoulos ECPellisé FCunningham MEPerez-Grueso FSGupta M: Late treatment of tuberculosis-associated kyphosis: literature review and experience from a SRS-GOP site. Eur Spine J 22:Suppl 46416462013

  • 3

    Brashear HRRendelman DA: Pott's paraplegia. South Med J 71:137913821978

  • 4

    Bydon MDe la Garza-Ramos RMacki MDesai AGokaslan AKBydon A: Incidence of sacral fractures and in-hospital postoperative complications in the United States: an analysis of 2002–2011 data. Spine (Phila Pa 1976) 39:E1103E11092014

  • 5

    Centers for Disease Control Prevention: Tuberculosis (TB) Data and Statistics. Centers for Disease Control and Prevention (http://www.cdc.gov/tb/statistics/default.htm) [Accessed October 19 2016]

  • 6

    Dara MDadu AKremer KZaleskis RKluge HH: Epidemiology of tuberculosis in WHO European Region and public health response. Eur Spine J 22:Suppl 45495552013

  • 7

    Dass BPuet TAWatanakunakorn C: Tuberculosis of the spine (Pott's disease) presenting as ‘compression fractures’. Spinal Cord 40:6046082002

  • 8

    De la Garza-Ramos RSamdani AFSponseller PDAin MCMiller NRShaffrey CI: Visual loss after corrective surgery for pediatric scoliosis: incidence and risk factors from a nationwide database. Spine J 16:5165222016

  • 9

    Friedman B: Chemotherapy of tuberculosis of the spine. J Bone Joint Surg Am 48:4514741966

  • 10

    Fuentes Ferrer MGutiérrez Torres LAyala Ramírez ORumayor Zarzuelo Mdel Prado González N: Tuberculosis of the spine. A systematic review of case series. Int Orthop 36:2212312012

  • 11

    Golden MPVikram HR: Extrapulmonary tuberculosis: an overview. Am Fam Physician 72:176117682005

  • 12

    Gruber PBoeni THistory of spinal disorders. Boos NAebi M: Spinal Disorders: Fundamentals of Diagnosis and Treatment BerlinSpringer2008

  • 13

    Leibert ESchluger NWBonk SRom WN: Spinal tuberculosis in patients with human immunodeficiency virus infection: clinical presentation, therapy and outcome. Tuber Lung Dis 77:3293341996

  • 14

    Liu ZWang XXu ZZeng HZhang PPeng W: Two approaches for treating upper thoracic spinal tuberculosis with neurological deficits in the elderly: A retrospective case-control study. Clin Neurol Neurosurg 141:1111162016

  • 15

    Mulleman DMammou SGriffoul IAvimadje AGoupille PValat JP: Characteristics of patients with spinal tuberculosis in a French teaching hospital. Joint Bone Spine 73:4244272006

  • 16

    Murray CJOrtblad KFGuinovart CLim SSWolock TMRoberts DA: Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384:100510702014

  • 17

    Pang XLi DWang XShen XLuo CXu Z: Thoracolumbar spinal tuberculosis in children with severe post-tubercular kyphotic deformities treated by single-stage closing-opening wedge osteotomy: preliminary report a 4-year follow-up of 12 patients. Childs Nerv Syst 30:9039092014

  • 18

    Papadopoulos ECBoachie-Adjei OHess WFSanchez Perez-Grueso FJPellisé FGupta M: Early outcomes and complications of posterior vertebral column resection. Spine J 15:9839912015

  • 19

    Parthasarathy RSriram KSantha TPrabhakar RSomasundaram PRSivasubramanian S: Short-course chemotherapy for tuberculosis of the spine. A comparison between ambulant treatment and radical surgery—ten-year report. J Bone Joint Surg Br 81:4644711999

  • 20

    Pott P: Remarks on that kind of palsy of the lower limbs which is frequently found to accompany a curvature of the spine and is supposed to be caused by it LondonJ. Johnson1779

  • 21

    Rasouli MRMirkoohi MVaccaro ARYarandi KKRahimi-Movaghar V: Spinal tuberculosis: diagnosis and management. Asian Spine J 6:2943082012

  • 22

    Schlesinger NLardizabal ARao JRao JMcDonald R: Tuberculosis of the spine: experience in an inner city hospital. J Clin Rheumatol 11:17202005

  • 23

    Tuli SM: Tuberculosis of the spine: a historical review. Clin Orthop Relat Res 460:29382007

  • 24

    Yoshihara HYoneoka D: Trends in the surgical treatment for spinal metastasis and the in-hospital patient outcomes in the United States from 2000 to 2009. Spine J 14:184418492014

  • 25

    Young KHEhman MReves RPeterson Maddox BLKhan AChorba TL: Tuberculosis contact investigations—United States, 2003–2012. MMWR Morb Mortal Wkly Rep 64:136913742016

Disclosures

Dr. Sciubba has consulting relationships with Medtronic, Globus, DePuy Synthes, and Orthofix. Dr. Goodwin is a UNCF (United Negro College Fund)/Merck Postdoctoral Fellow and has received an award from the Burroughs Wellcome Fund and the Johns Hopkins Neurosurgery Pain Research Institute. Dr. Bydon received support of a non–study-related clinical or research effort that he oversaw from DePuy Spine, and he is on the advisory board for MedImmune. Dr. Witham received support of a non–study-related clinical or research effort that he oversaw from Eli Lilly and Co. and from the Gordon and Marilyn Macklin Foundation. Dr. Wolinsky is a consultant for Medtronic, DePuy Synthes, Globus, Orthofix, and Stryker.

Author Contributions

Conception and design: Sciubba, De la Garza Ramos. Acquisition of data: Sciubba, De la Garza Ramos, Goodwin. Analysis and interpretation of data: all authors. Drafting the article: all authors. Critically revising the article: Sciubba, De la Garza Ramos, Bydon, Witham, Wolinsky. Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: Sciubba. Statistical analysis: Sciubba, De la Garza Ramos, Goodwin, Abu-Bonsrah. Study supervision: Sciubba, Bydon, Witham, Wolinsky.

Supplemental Information

Current Affiliations

Dr. De la Garza Ramos: Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.

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Article Information

INCLUDE WHEN CITING Published online December 16, 2016; DOI: 10.3171/2016.9.SPINE16174.

Drs. De la Garza Ramos and Goodwin contributed equally to this work.

Correspondence Daniel M. Sciubba, Department of Neurosurgery, The Johns Hopkins Hospital, 600 North Wolfe St., Meyer 5-185, Baltimore, MD 21287. email: dsciubb1@jhmi.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Graph showing the population growth–adjusted incidence rate of patients with a discharge diagnosis of spinal TB in the US from 2002 to 2011. After a peak in 2003, the incidence was found to decrease significantly over time (p < 0.001). Figure is available in color online only.

  • View in gallery

    Bar graph showing the proportion of patients with spinal TB among all TB cases. The proportion was found to decrease significantly, from 4.1% in 2002 to 2.6% in 2011 (p < 0.001). Figure is available in color online only.

  • View in gallery

    A 21-year-old woman, an immigrant, presented to our institution with a severe kyphotic deformity of the thoracic spine and mild paraparesis secondary to TB. Left: Preoperative CT scan of the thoracic spine showing destruction of T-7, T-8, and T-9, with severe focal kyphosis. Right: Preoperative T2-weighted MR image showing focal kyphotic deformity and spinal cord compression.

  • View in gallery

    The same patient depicted in Fig. 3 underwent a combined anterolateral-posterior approach. The first stage consisted of a right-sided thoracotomy, resection of rib, and corpectomy of T-7, T-8, and T-9. This was followed by placement of a distractible cage, plate, and screws, reduction of kyphosis, and arthrodesis using allograft and local autograft from T-6 to T-10. This was followed by drainage of abscess. The second stage consisted of pedicle screw instrumentation from T-3 to T-12 and arthrodesis performed using locally obtained autograft, allograft, and demineralized bone matrix. Left: Postoperative CT image showing the distractible cage between T-6 and T-10. Right: Postoperative radiograph showing anterior and posterior reconstruction.

References

1

Alami NNYuen CMMiramontes RPratt RPrice SFNavin TR: Trends in tuberculosis—United States, 2013. MMWR Morb Moral Wkly Rep 63:2292332014

2

Boachie-Adjei OPapadopoulos ECPellisé FCunningham MEPerez-Grueso FSGupta M: Late treatment of tuberculosis-associated kyphosis: literature review and experience from a SRS-GOP site. Eur Spine J 22:Suppl 46416462013

3

Brashear HRRendelman DA: Pott's paraplegia. South Med J 71:137913821978

4

Bydon MDe la Garza-Ramos RMacki MDesai AGokaslan AKBydon A: Incidence of sacral fractures and in-hospital postoperative complications in the United States: an analysis of 2002–2011 data. Spine (Phila Pa 1976) 39:E1103E11092014

5

Centers for Disease Control Prevention: Tuberculosis (TB) Data and Statistics. Centers for Disease Control and Prevention (http://www.cdc.gov/tb/statistics/default.htm) [Accessed October 19 2016]

6

Dara MDadu AKremer KZaleskis RKluge HH: Epidemiology of tuberculosis in WHO European Region and public health response. Eur Spine J 22:Suppl 45495552013

7

Dass BPuet TAWatanakunakorn C: Tuberculosis of the spine (Pott's disease) presenting as ‘compression fractures’. Spinal Cord 40:6046082002

8

De la Garza-Ramos RSamdani AFSponseller PDAin MCMiller NRShaffrey CI: Visual loss after corrective surgery for pediatric scoliosis: incidence and risk factors from a nationwide database. Spine J 16:5165222016

9

Friedman B: Chemotherapy of tuberculosis of the spine. J Bone Joint Surg Am 48:4514741966

10

Fuentes Ferrer MGutiérrez Torres LAyala Ramírez ORumayor Zarzuelo Mdel Prado González N: Tuberculosis of the spine. A systematic review of case series. Int Orthop 36:2212312012

11

Golden MPVikram HR: Extrapulmonary tuberculosis: an overview. Am Fam Physician 72:176117682005

12

Gruber PBoeni THistory of spinal disorders. Boos NAebi M: Spinal Disorders: Fundamentals of Diagnosis and Treatment BerlinSpringer2008

13

Leibert ESchluger NWBonk SRom WN: Spinal tuberculosis in patients with human immunodeficiency virus infection: clinical presentation, therapy and outcome. Tuber Lung Dis 77:3293341996

14

Liu ZWang XXu ZZeng HZhang PPeng W: Two approaches for treating upper thoracic spinal tuberculosis with neurological deficits in the elderly: A retrospective case-control study. Clin Neurol Neurosurg 141:1111162016

15

Mulleman DMammou SGriffoul IAvimadje AGoupille PValat JP: Characteristics of patients with spinal tuberculosis in a French teaching hospital. Joint Bone Spine 73:4244272006

16

Murray CJOrtblad KFGuinovart CLim SSWolock TMRoberts DA: Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384:100510702014

17

Pang XLi DWang XShen XLuo CXu Z: Thoracolumbar spinal tuberculosis in children with severe post-tubercular kyphotic deformities treated by single-stage closing-opening wedge osteotomy: preliminary report a 4-year follow-up of 12 patients. Childs Nerv Syst 30:9039092014

18

Papadopoulos ECBoachie-Adjei OHess WFSanchez Perez-Grueso FJPellisé FGupta M: Early outcomes and complications of posterior vertebral column resection. Spine J 15:9839912015

19

Parthasarathy RSriram KSantha TPrabhakar RSomasundaram PRSivasubramanian S: Short-course chemotherapy for tuberculosis of the spine. A comparison between ambulant treatment and radical surgery—ten-year report. J Bone Joint Surg Br 81:4644711999

20

Pott P: Remarks on that kind of palsy of the lower limbs which is frequently found to accompany a curvature of the spine and is supposed to be caused by it LondonJ. Johnson1779

21

Rasouli MRMirkoohi MVaccaro ARYarandi KKRahimi-Movaghar V: Spinal tuberculosis: diagnosis and management. Asian Spine J 6:2943082012

22

Schlesinger NLardizabal ARao JRao JMcDonald R: Tuberculosis of the spine: experience in an inner city hospital. J Clin Rheumatol 11:17202005

23

Tuli SM: Tuberculosis of the spine: a historical review. Clin Orthop Relat Res 460:29382007

24

Yoshihara HYoneoka D: Trends in the surgical treatment for spinal metastasis and the in-hospital patient outcomes in the United States from 2000 to 2009. Spine J 14:184418492014

25

Young KHEhman MReves RPeterson Maddox BLKhan AChorba TL: Tuberculosis contact investigations—United States, 2003–2012. MMWR Morb Mortal Wkly Rep 64:136913742016

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