Tuberculous Retropharyngeal Space Abscess

Epidemiology

The most common cause of vertebral body infection throughout the world is tuberculosis. This is particularly evident in developing countries but with the current acquired immune deficiency syndrome (AIDS) epidemic, there is a recrudescence of spinal tuberculosis in Western countries. Approximately 75% of cases of spinal tuberculosis occur before the age of 20 years.

Clinical Findings

Patients may present with fever, weight loss, neck pain, or dysphagia. Patients with destruction of the vertebral bodies may show deformity of the spine. Epidural spread produces neurological deficit in 10 to 20% of patients.

Pathology

Tuberculosis involving the spine is usually secondary to hematogenous spread from the lungs. In children, spinal infection begins in the richly vascularized end plates and discs. In adults, as a result of involution of the rich blood supply to the end plates, infection usually starts in the metaphyseal area adjacent to the anterior longitudinal ligament. Infection may subsequently spread subligamentously or to the intervertebral disc. Extension through the anterior longitudinal ligament leads to the formation of prevertebral or retropharyngeal abscess. Destruction of the vertebral body results in acute angulation of the spine.