Spinal tuberculosis, natural history of disease, classifications and principles of management with historical perspective.

PURPOSE: To describe the natural history spinal tuberculosis, classifications and principles of management based upon the grading of the neurological deficit.
METHODS: Review of literature was conducted with the aim to provide the clinico-radiological correlation of the natural history of spinal tuberculosis in different stages. Management strategy is developed based upon the severity of the neurological deficit.
RESULTS: A five stage natural history of spinal tuberculosis is described. Stage of neurological involvement is further divided into 4 grades, predominantly on the basis of progressively increasing motor deficits as negligible, mild, moderate and severe with sensory and autonomic dysfunctions. Suitable principles of management with role of rest, braces, chemotherapy and surgery are discussed. Neurological deficit grading based management is developed. Grade 1 and 2, conservative treatment, grade 3, gray zone and grade 4, operative treatment is emphasized.
CONCLUSION: The five stages of natural history of tuberculosis of spine have been developed from the clinician's point of view. Management of tuberculosis of spine, in general, it is no different than management of soft tissue tuberculosis, in HIV negative or positive patients. Role of surgery is very limited. Management of tubercular paraplegia, based upon the grading of paraplegia is simple, logical, efficient and easy to understand and remember by any orthopedic surgeon.