Tumor necrosis factor-alpha antagonists in patients with complicated spinal tuberculosis: A case series and literature review

Abstract

Introduction

Spinal tuberculosis is often associated with poor outcomes; host-directed inflammation involving the spine contributes to this disability.

Methods

A retrospective review of patients with complicated spinal tuberculosis having received tumor necrosis factor-alpha (TNF-α) antagonists at a referral hospital in South Africa. A literature review was performed to identify all published cases of complicated spinal tuberculosis that received a TNF-α antagonist as part of their treatment.

Results

We describe 23 cases, of which 19 were previously reported in the literature. All patients were treated with either thalidomide (n = 6) or infliximab (n = 16), except for one who received both. All in all, 21 (91%) cases improved neurologically and, at the end of follow-up, 18 could walk.

Conclusion

There is accumulating experience to confer the efficacy and safety of TNF-α antagonists in treating complicated spinal tuberculosis cases. Evidence from randomized controlled trials is urgently required to substantiate these findings.