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Tuberculous myelitis: a systematic review of published case reports and case series

Spinal Cord Series and Cases volume 11, Article number: 6 (2025) Cite this article

Subjects

Abstract

Study design

A systematic review.

Objectives

Tuberculous myelitis, an uncommon disorder, often manifests as transverse myelopathy. The majority of the literature comprises isolated case reports, necessitating a systematic review for better understanding and management.

Setting

Uttar Pradesh India.

Methods

Our review followed PRISMA guidelines, searching PubMed, Scopus, Embase, and Google Scholar with no language constraints. Quality assessment of reports was based on selection, ascertainment, causality, and reporting. Data synthesis was qualitative with categorical and continuous data representation.

Results

We analyzed 34 reports describing 39 individuals. The majority (85%) had a duration of illness of one month or less. Upper motor neuron paraparesis was the most common neurological manifestation (69.2%), followed by areflexic paraparesis (15.3%). Paradoxical reactions occurred in 20.5% of cases. Microbiological confirmation was achievable in approximately 77% of cases. Neuroimaging abnormalities were present in 41% of cases, and chest imaging abnormalities in 53.9%. Longitudinally-extensive hyperintensities in cervical and thoracic regions were common spinal imaging abnormalities. Central nervous system tuberculosis was confirmed in 47.7% of cases, while pulmonary and disseminated tuberculosis were each found in 25.6%. Improvement was noted in 87.2% of cases, while 10.3% did not improve or died.

Conclusion

Tuberculous myelitis, is a distinct spinal cord disease. Most cases had microbiological confirmation, and the majority showed improvement with treatment.

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Data availability

All data generated or analysed during this study are included in this published article and its supplementary information files.

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Authors and Affiliations

  1. Department of Neurology, King George’s Medical University, Lucknow, 226003, India

    Ravindra Kumar Garg, Neeraj Kumar, Ravi Uniyal, Praveen Kumar Sharma, Hardeep Singh Malhotra & Imran Rizvi

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  1. Ravindra Kumar Garg
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Contributions

RKG: Conceptualization, Methodology, Literature Search, Data Curation, Formal Analysis, Writing—Original Draft, Writing—Review & Editing. NK: Methodology, Literature Search, Data Extraction, Quality Assessment, Writing—Review & Editing. RU: Data Curation, Writing—Review & Editing. PKS: Supervision, Conceptualization, Writing—Review & Editing, Final Approval. HSM: Quality Assessment, Visualization, Writing—Review & Editing. IR: Supervision, Writing—Review & Editing, Final Approval.

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Correspondence to Ravindra Kumar Garg.

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Garg, R.K., Kumar, N., Uniyal, R. et al. Tuberculous myelitis: a systematic review of published case reports and case series. Spinal Cord Ser Cases 11, 6 (2025). https://doi.org/10.1038/s41394-025-00701-5

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