title: The course of spinal tuberculosis (Pott disease): results of the multinational, multicentre Backbone-2 study.
abstract: We aimed to describe clinical, laboratory, diagnostic and therapeutic features of spinal tuberculosis (ST), also known as Pott disease. A total of 314 patients with ST from 35 centres in Turkey, Egypt, Albania and Greece were included. Median duration from initial symptoms to the time of diagnosis was 78 days. The most common complications presented before diagnosis were abscesses (69%), neurologic deficits (40%), spinal instability (21%) and spinal deformity (16%). Lumbar (56%), thoracic (49%) and thoracolumbar (13%) vertebrae were the most commonly involved sites of infection. Although 51% of the patients had multiple levels of vertebral involvement, 8% had noncontiguous involvement of multiple vertebral bodies. The causative agent was identified in 41% of cases. Histopathologic examination was performed in 200 patients (64%), and 74% were consistent with tuberculosis. Medical treatment alone was implemented in 103 patients (33%), while 211 patients (67%) underwent diagnostic and/or therapeutic surgical intervention. Ten percent of the patients required more than one surgical intervention. Mortality occurred in 7 patients (2%), and 77 (25%) developed sequelae. The distribution of the posttreatment sequelae were as follows: 11% kyphosis, 6% Gibbus deformity, 5% scoliosis, 5% paraparesis, 5% paraplegia and 4% loss of sensation. Older age, presence of neurologic deficit and spinal deformity were predictors of unfavourable outcome. ST results in significant morbidity as a result of its insidious course and delayed diagnosis because of diagnostic and therapeutic challenges. ST should be considered in the differential diagnosis of patients with vertebral osteomyelitis, especially in tuberculosis-endemic regions. Early establishment of definitive aetiologic diagnosis and appropriate treatment are of paramount importance to prevent development of sequelae.
authors.affiliation: Dr Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Batirel
authors.affiliation: Gulhane Medical Academy, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey. Electronic address: hakanerdem1969@yahoo.com.
authors.forename: H
authors.initials: H
authors.lastname: Erdem
authors.affiliation: Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Sengoz
authors.affiliation: Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: F
authors.initials: F
authors.lastname: Pehlivanoglu
authors.affiliation: Infectious Diseases Hospital, University Hospital Center "Mother Teresa", Tirana, Albania.
authors.forename: E
authors.initials: E
authors.lastname: Ramosaco
authors.affiliation: Diyarbakir Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Gülsün
authors.affiliation: Dicle University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey.
authors.forename: R
authors.initials: R
authors.lastname: Tekin
authors.affiliation: Istanbul University Cerrahpasa School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Mete
authors.affiliation: Istanbul University Cerrahpasa School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: I I
authors.initials: II
authors.lastname: Balkan
authors.affiliation: Sisli Etfal Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: D Y
authors.initials: DY
authors.lastname: Sevgi
authors.affiliation: Department of Internal Medicine, Athens University Medical School, Attikon University General Hospital, Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Giannitsioti
authors.affiliation: Department of Internal Medicine, Athens University Medical School, Attikon University General Hospital, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Fragou
authors.affiliation: Karadeniz Technical University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Kaya
authors.affiliation: Koc University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Cetin
authors.affiliation: Koc University School of Medicine, Department of Neurosurgery, Istanbul, Turkey.
authors.forename: T
authors.initials: T
authors.lastname: Oktenoglu
authors.affiliation: Trakya University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Edirne, Turkey.
authors.forename: A D
authors.initials: AD
authors.lastname: Celik
authors.affiliation: Izmir Bozyaka Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Karaca
authors.affiliation: Mersin University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Mersin, Turkey.
authors.forename: E S
authors.initials: ES
authors.lastname: Horasan
authors.affiliation: Private Umit Hospital, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Ulug
authors.affiliation: Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Senbayrak
authors.affiliation: Diyarbakir Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Kaya
authors.affiliation: Kocaeli University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kocaeli, Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Arslanalp
authors.affiliation: The University of Texas Health Science Center at Houston, Medical School, Department of Infectious Diseases, Turkey.
authors.forename: R
authors.initials: R
authors.lastname: Hasbun
authors.affiliation: Sutcu Imam University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kahramanmaras, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Ates-Guler
authors.affiliation: Kocaeli University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kocaeli, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Willke
authors.affiliation: Celal Bayar University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Manisa, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Senol
authors.affiliation: Akdeniz University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey.
authors.forename: D
authors.initials: D
authors.lastname: Inan
authors.affiliation: Sakarya University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sakarya, Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Güclü
authors.affiliation: Ankara Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors.forename: G T
authors.initials: GT
authors.lastname: Ertem
authors.affiliation: Kocaeli University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kocaeli, Turkey.
authors.forename: M M
authors.initials: MM
authors.lastname: Koc
authors.affiliation: Ege University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Tasbakan
authors.affiliation: Dr Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Ocal
authors.affiliation: Acibadem University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Kocagoz
authors.affiliation: Acibadem University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Kusoglu
authors.affiliation: Ankara Atatürk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors.forename: T
authors.initials: T
authors.lastname: Güven
authors.affiliation: Yuzuncuyil University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Van, Turkey.
authors.forename: A I
authors.initials: AI
authors.lastname: Baran
authors.affiliation: Umraniye Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Dede
authors.affiliation: Medeniyet University, Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: F Y
authors.initials: FY
authors.lastname: Karadag
authors.affiliation: Ondokuz Mayis University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Yilmaz
authors.affiliation: Diskapi Yildirim Beyazit Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Aslan
authors.affiliation: Neurosurgery Department, Egypt.
authors.forename: D A
authors.initials: DA
authors.lastname: Al-Gallad
authors.affiliation: Ankara Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Cesur
authors.affiliation: Medical Microbiology and Immunology, Infection Control Unit, Zagazig University, Zagazig, Egypt.
authors.forename: R
authors.initials: R
authors.lastname: El-Sokkary
authors.affiliation: Izzet Baysal University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bolu, Turkey.
authors.forename: F
authors.initials: F
authors.lastname: Sirmatel
authors.affiliation: Gulhane Medical Academy, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors.forename: U
authors.initials: U
authors.lastname: Savasci
authors.affiliation: GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Karaahmetoglu
authors.affiliation: Medeniyet University, Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Vahaboglu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000008:administration & dosage; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D007391:International Cooperation; D008297:Male; D019083:Mediterranean Region / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative; D016019:Survival Analysis; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: Pott disease; spinal tuberculosis; spondylitis; spondylodiscitis; vertebral osteomyelitis