Tuberculous
osteomyelitis
Tuberculous osteomyelitis is rare and occurs following haematogenous
spread from the primary focus in the lung or in the gut. In the spine it is
usual for two adjacent vertebral bodies to be involved (Pott’s disease). The
vertebrae collapse but the posterior structures remain intact, so the spine
angulates
into a kyphos. An abscess forms, which may put pressure on to the spinal cord
or the nerve roots, but which also tracks forward in the prevertebral space.
From there it follows fascia, and in the case of low thoracic or lumbar tuberculosis
may follow the psoas muscle from its original origin to its insertion in the
lesser trochanter of the femur. There
In
the developed world, tuberculosis is again on the increase in patients who are
immunocompromised either because of diseases such as acquired immunnodeflciency
syndrome (AIDS) or because they have been immunosuppressed. The organism is
becoming increasingly resistant to standard antibiotics such as rifampicin. The
failure of some patients, such as drug addicts, to comply fully with the
treatment regime, further increases the risk of spread of antibiotic-resistant
tuberculosis.