Multifocal tuberculous spondylodiscitis of the entire spine: a comprehensive review of concepts, practices, and evidence-based recommendations

Introduction: This review aims to assess published cases of multifocal tuberculous spondylodiscitis (MTS) with whole-spine involvement, examining current concepts, management strategies, and providing evidence-based recommendations. Methods: A systematic review of case reports and series on MTS with full spinal involvement was conducted across databases, including PubMed, Google Scholar, and Web of Science, up to 2023. Data on patient demographics, clinical presentation, predisposing factors, spinal and extra-spinal locations, imaging findings, diagnostic methods, biochemical markers, management approaches, complications, and outcomes were collected and analyzed. Fourteen reports, representing 16 patients, met the inclusion criteria. Results: Radiologically, central lesions were present in all cases, with additional patterns including axial/anterior lesions in 62.5% and paradiscal involvement in 37.5%. Extensive spinal involvement was observed in the cervical, dorsal, lumbar, and sacral regions in all patients, and 68.75% had associated axial skeleton involvement (e.g., sternum, ribs, pelvis). Anti-tuberculosis (TB) therapy was administered to all patients, with treatment durations varying from 8 to 18 months. Surgical intervention was required in 56.25% of cases, primarily for spinal cord compression and progressive deformities. Follow-up data indicated that 93.75% of patients achieved pain resolution, and 68.75% experienced neurological recovery, with no recurrence observed at follow-up intervals of up to 4 years. Conclusion: Effective management of MTS involving the entire spine requires thorough clinical evaluation, tailored anti-TB chemotherapy, monitoring for drug resistance, and judicious surgical intervention when necessary. Routine use of whole-spine magnetic resonance imaging is essential for detecting multifocal lesions and guiding comprehensive treatment strategies to improve patient outcomes.