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Tuberculosis of the spinal cord
Divyani Garg1, Divya M Radhakrishnan2, Umang Agrawal3, Harshad Arvind Vanjare4, Edmond Jonathan Gandham5, Abi Manesh6
1 Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
2 Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
3 Department of Infectious Diseases, PD Hinduja Hospital and MRC, Mumbai, Maharashtra, India
4 Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
5 Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
6 Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
Correspondence Address:
Abi Manesh,
Department of Infectious Diseases, Infectious Diseases Research and Training Centre (IDTRC), Christian Medical College, Vellore - 632 004, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/aian.aian_578_22
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Tuberculosis involving the spinal cord is associated with high mortality and disabling long-term sequelae. Although tuberculous radiculomyelitis is the most frequent complication, pleomorphic clinical manifestations exist. Diagnosis can be challenging among patients with isolated spinal cord tuberculosis due to diverse clinical and radiological presentations. The principles of management of tuberculosis of the spinal cord are primarily derived from, and dependent upon, trials on tuberculous meningitis (TBM). Although facilitating mycobacterial killing and controlling host inflammatory response within the nervous system remain the primary objectives, several unique features require attention. The paradoxical worsening is more frequent, often with devastating outcomes. The role of anti-inflammatory agents such as steroids in adhesive tuberculous radiculomyelitis remains unclear. Surgical interventions may benefit a small proportion of patients with spinal cord tuberculosis. Currently, the evidence base in the management of spinal cord tuberculosis is limited to uncontrolled small-scale data. Despite the gargantuan burden of tuberculosis, particularly in lower and middle-income countries, large-scale cohesive data are surprisingly sparse. In this review, we highlight the varied clinical and radiological presentations, performance of various diagnostic modalities, summarize data on the efficacy of treatment options, and propose a way forward to improve outcomes in these patients.
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