SA Orthopaedic Journal
On-line version ISSN 2309-8309
DUNN, R. The medical management of spinal tuberculosis. SA orthop. j. [online]. 2010, vol.9, n.1, pp. 37-41. ISSN 2309-8309.
The overall prevalence of spinal tuberculosis (TB) in South Africa is currently 948 per 100 000. All trends are upward, including incidence of sputa positive cases, relapses and retreatment rates, as well as new extra-pulmonary cases. This is driven by the co-existent HIV endemic and the effect of HIV on TB re-activation.1 Autopsy studies confirm that 30-40% of HIV-positive patients die of TB and 44% of TB patients have HIV.2 Musculoskeletal manifestations of TB are more frequent in the HIV host, reported as high as 60% compared to the normal 3-5% incidence.3 TB is largely a public health issue and will only be controlled when the problems of abject poverty such as malnutrition, overcrowding and early access to medical care is improved. To this end it is notifiable by law in an effort to allow preventative measures to be effected. TB spine represents about 1% of overall cases but places a large demand on resources due to the costs of paraplegia and tertiary level care. Although surgery is indicated in selected cases, medical care remains the key component. Medical care involves both the diagnostic process and the medical intervention by means of supportive care and anti-tuberculous chemotherapy.