Evidence & Methods
Kenya has an exceptionally high burden of tuberculosis infection, and much of this is associated with HIV immunosuppression. While this association has been the subject of considerable research, there is little modern data available on spinal tuberculosis in HIV-negative patients.
The authors present data from a single large tertiary center from a 5-year period and note that the vast majority of patients presented with advanced disease of the spine. Three-quarters had severe back pain or weakness, and two-thirds had gross kyphosis or neurologic impairment. Most patients responded to chemotherapeutic or surgical intervention with improvement.
These data highlight that spinal tuberculosis is not limited to patients with HIV infection. Limited resources, poor nutrition, concomitant disease, and limited access to routine healthcare negatively impact patients with spinal disorders globally. These factors perpetuate the prevalence of serious spinal infections. Patients often present late in the course of their disease and with a greater likelihood of significant morbidity and mortality. Efforts to address these issues, while ongoing and admirable, are currently insufficient.
—The Editors