TUBERCULOSIS OF THE SPINE - REVIEW OF 63 CASES

Objective: to study tuberculosis of the spine in patients managed at a rheumatology department in Morocco. Patients and Methods. retrospecti ve review of patients seen over a 15-year period (1980-1994). Inclusio n criteria were evidence of discitis on plain radiographs plus any of the following: recovery of the tubercle bacillus from the spinal focus or another lesion; histologic findings suggestive of tuberculosis; or clinical, laboratory test, radiological and outcome features highly s uggestive of tuberculosis (<<presumptive evidence>>). Results. 63 pati ents were included, 44 women (70%) and 19 men, with a mean age of 44+/ -15 years (range, 8-80 years). Mean time to diagnosis was 10+/-8 month s (range, 1-36 months). Tile lumbar spine was the most common site of involvement (n=55, 68%). A deformity of the spine was noted in 57% of cases, and neurological abnormalities in 16%. The diagnosis was based on recovery of the tubercle bacillus in 49% of cases, histologic findi ngs in 9.5%, and presumptive evidence in 41% of cases. Extraspinal foc i of tuberculosis were found in 27 patients (43%), with the following distribution: bones and joints, 11%; lungs, 21%; urinary system, 13%; skin, 6%; and lymph nodes, 1.5%, Discussion the peak age of occurrence of tuberculosis in developing countries has shifted from childhood to young adulthood, probably as a result of campaigns of routine BCG vac cination at birth. Tuberculosis remains endemic in developing countrie s, where the limited access to health care leads to delayed diagnosis at the stage of advanced disease.