Disparities in the clinical profile of spinal tuberculosis in Africa: a scoping review of management and outcome.

Abstract

Background: Spinal tuberculosis (STB) is a significant contributor to non-traumatic myelopathy. There is a rising burden in Africa, in parallel with the high prevalence of human immunodeficiency virus. We conducted a scoping review to highlight the disparities in the management and outcomes of STB in Africa.

Methods: This study was conducted using the preferred reporting systems for systematic review and meta-analysis extension for scoping review guidelines. AJOL, Embase, MEDLINE, Google Scholar, and Cochrane CENTRAL databases were searched to identify all relevant peer-reviewed articles published on the management of STB in African centres, excluding abstract-only articles, literature reviews, and meta-analyses.

Results: 60 studies were eligible for inclusion, comprising data from 3416 patients aged eight months to 89 years (median, 32 years). Thoracic and lumbar segments were the most commonly affected vertebral regions (Thoracic = 42.7%; Lumbar = 35.9%). The most common clinical features were back pain and neurological deficits. Lack of essential laboratory and imaging diagnostic infrastructure was a common problem. Patients received antitubercular therapy (ATT) for varying durations and only 18.3% underwent surgery. A favourable outcome was achieved in 51.6% of patients, 20.3% developed a permanent disability, and the mortality rate was 2.1%. Treatment outcome was adversely affected by a high rate of late presentation and treatment default.

Conclusions: ATT remains the mainstay of treatment, however, the duration of treatment varied widely among studies. Further research is required to explore the feasibility and efficacy of short-course ATT in treating STB in the African population.