Spinal Tuberculosis — SCE Infectious Diseases MCQ

Instant feedback + full explanation. One question, done properly.

ModerateTuberculosisSpinal TuberculosisSCE Infectious Diseases

A 43-year-old woman from Bangladesh presents with a large fluctuant paraspinal collection at the thoracolumbar junction with kyphotic deformity. MRI shows destruction of T12 and L1 vertebral bodies with a large pre-vertebral and psoas abscess. Biopsy shows caseating granulomata. What is the recommended treatment duration?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — 6 months of standard anti-TB therapy (2RHZE/4RH)

This is spinal tuberculosis (Pott disease): vertebral body destruction with paraspinal/pre-vertebral and psoas abscess, supported by caseating granulomata. Under current UK NICE guidance, active TB without central nervous system involvement is treated with standard 6-month therapy: 2 months of rifampicin, isoniazid with pyridoxine, pyrazinamide and ethambutol, followed by 4 months of rifampicin and isoniazid. NICE specifically states that active spinal TB without CNS involvement should not have treatment extended beyond 6 months merely because of residual kyphosis, vertebral loss or other residual spinal effects. A 12-month regimen is for CNS TB; surgery is not routine to eradicate spinal TB and is considered separately only if there is spinal instability or cord compression. Therefore the recommended treatment duration is 6 months: 2RHZE/4RH.

Reference: NICE Guideline NG33, Tuberculosis: prevention, diagnosis, management and service organisation, last updated 16 February 2024. Recommendations 1.3.7.2 and 1.3.7.5. https://www.nice.org.uk/guidance/ng33/chapter/Recommendations