Noncontiguous Multiple Spinal Tuberculosis

Dear Editor, we would like to discuss on the publication on "noncontiguous multiple spinal tuberculosis1)." Kim et al. noted that "the disease should be considered in differential diagnosis along with other diseases such as metastatic neoplasm, pyogenic spondylitis, especially when the radiologic studies are revealing multiple spinal lesions1)" As noted by Kim, "multi-level noncontiguous, remote vertebral tuberculosis" is not common and sometimes difficult to diagnose. To diagnose the case, the microbiological diagnosis is sometimes not available and presumptive diagnosis is used2). The use of antituberculosis drug is needed and surgery might be used in cases with "large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment3)." The challenge in the case with noncontiguous multiple spinal tuberculosis is the multiple level surgery. Based on the experience reported from Taiwan of China, it is noted that "decompression at all lesion levels" should be used in a patient with multiple-level compression symptom4).