Spinal tuberculosis is an infection of the spine by the bacteria Mycobacterium tuberculosis that causes destruction and deformities of the bones. If not detected and treated, it can lead to permanent disability due to paralysis of the lower extremities. This condition accounts for 50% of tuberculosis in the musculoskeletal system and 2% of all tuberculosis cases. Due to its nonspecific signs and symptoms, many cases are diagnosed late.

This PEER project aimed to describe the epidemiology of spinal tuberculosis, identify the characteristics of persons with spinal tuberculosis in Indonesia, and explore the perceptions of persons with spinal tuberculosis about their condition, including the reasons for delaying seeking treatment. Identifying risk factors for spinal tuberculosis is essential to reach those most susceptible so that proper educational campaigns can be designed and early interventions can reduce the risk. Information on risk factors also helps increase the vigilance of healthcare professionals in suspecting spinal tuberculosis earlier in patients presenting with relevant symptoms. The mixed-method study was conducted in five provinces in Indonesia.

Final Summary of Project Activities

The team used a retrospective review of medical records, cross sectional survey, and in-depth interviews to develop their findings. They collected and analyzed data from the 2017-2021 medical records of patients diagnosed with spinal tuberculosis from three national hospitals in Indonesia that provide care for spinal diseases (data from two additional hospitals were delayed despite obtaining ethical clearance and administrative letters). A total of 673 medical records were retrieved and reviewed, and researchers contacted patients who lived within 20 km of the hospitals for a follow-up survey and exam. However, the response rate was low, with only 58 patients participating.

The researchers also conducted in-depth interviews of 15 patients with spinal tuberculosis. They plan to develop two manuscripts for publication, as well as share their work at the Asia Pacific Region Conference of the International Union Against Tuberculosis and Lung Disease (APRC 2024). The PI Dr. Ferdiana participated in the August 2022 meeting of SPINE20 in Bali, and a mentee presented at the International Conference for Tropical Medicine. The PI and a mentee also delivered a favorably received module on disability for undergraduate medical students at Universitas Mataram. The PI has been appointed as the national coordinator for the international survey for spinal cord injury in Indonesia and was promoted to assistant professor.

This project also involved a series of professional development trainings for the research team and related mentees, including on academic writing, research methods, ethics, and protocols for conducting basic physical examinations for testing neurological deficits.