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J Eval Clin Pract. 2019 Nov 26. doi: 10.1111/jep.13309. [Epub ahead of print]

Spinal tuberculosis: A systematic review of case studies and development of an evidence-based clinical guidance tool for early detection.

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Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg, South Africa.
Department of Rehabilitation Sciences, School of Medicine, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.



Despite research being done on spinal tuberculosis, diagnosing this condition at an early stage remains problematic due to its insidious onset and the varying symptoms being associated. Most individuals present to the health care facility with either simple back pain at an early stage or neurological complications at a later stage, when spinal compression and vertebral collapse have occurred as a result of delayed diagnosis. The prevention of secondary complications is therefore dependent on early recognition and diagnosis. The objective of this review was to identify common clinical patterns in case presentations and develop an evidence-based clinical guidance tool to assist clinicians in the early identification of spinal tuberculosis.


A comprehensive literature search was conducted for published spinal tuberculosis case studies, which yielded 28 cases after critical appraisal. Data from the studies were categorized in order to assist with a factor analysis and the development of an evidence framework for screening and diagnosing spinal tuberculosis. An evidence-based clinical guidance tool was then designed from the data obtained.


Factors associated with spinal tuberculosis and frequently reported symptoms and physical signs with which the patient could present upon assessment were identified. Options for investigations at primary, secondary, and tertiary levels were also identified.


Through the use of an evidence-based clinical guidance tool, the clinician could be guided in the early suspicion and management of individuals with spinal tuberculosis and prevention of secondary complications.


clinical guidance; diagnosis; primary care; risk factors; signs and symptoms; spinal tuberculosis


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