Title: Comparison of Surgical and Conservative Treatment for Spinal Tuberculosis

Authors: Dr Richa Sharma, Dr M.A Basit

 DOI: https://dx.doi.org/10.18535/jmscr/v7i10.11

Abstract

  

Treatment of spine has evolved much since Percivall Pott's first description of vertebral tuberculosis. However, there are still a lot of controversies regarding the best approache for prevention of deformities. The objective of this study was to evaluate the clinical and X-ray characteristics of patients with vertebral tuberculosis and to compare the conservative treatment alone to the surgical one associated with antitubercular therapy, particularly regarding residual deformity and neurological deficit. .152 patients were evaluated: 52 were surgically treated. Among 152 patients, 100 (65%) cases were treat conservatively with antitubercular therapy only. Remaining 52 (35%) cases were treated by surgical intervention in combination with chemotherapy. In this study among 100 patients treated conservatively, 80(80%) showed significant improvement of neurological status and constitutional symptoms. Other 20 (20%) showed no improvement or deterioration of neurological status. In this series among 52 patients treated by surgical intervention, 50 (96%) showed significant improvement of neurological symptoms, But 2 (4%) patient failed to improve neurological status even after surgical treatment.

Keywords: Tuberculosis; Spine; Kyphosis.

References

  1. Nussbaum ES, Rockswold GL, Bergman TA, Erickron DL, Seljeckong El. Spinal tuberculosis: a diagnosis and management challenge. J Neurosurg 1995;83:243-7.
  2. Rajasekaran S, Shanmugasundaram TK, Prabhakar R, Dheenadhayalan J, Shetty AP, Shetty Dk., Tuberculosis Lesions of the Lumbosacral region. A 15 year follows up of patients treated with ambulant chemotherapy. Spine 1998;23:1163-7
  3. Ousehal A, Gharbi A, Zamiati W, Saidi A, Kadiri R. Imaging findings in 122 cases of pott’s disease. Neurochirurgic 2002;48(5):409-18
  4. Parthasarathy R, Sriram K, Santha T, Prabhakar R, Somasundaram PR, Sivasubramanian S. Short course Chemotherapy for tuberculosis of the spine. A compamson between ambulant treatment and radical surgery -ten years report. J Bone Joint Surg Br 1999;81(3):464 -71
  5. Mukhtar AM, Farghaly MM, Ahmed SH. Surgical treatment of thoracic and tuberculosis by anterior inter body fusion and posterior instrumentation. Med Princ Pract 2003;12(2):92-6
  6. Lolge S, Maheshwari M, Shah J, Patkar D, Chawla A. Isolated solitary vertebral body tuberculosis- study of seven cases. Clin Radio 2003;58(7):545-50
  7. Ramarnurthi B, Tandon PN. Texibook of Neurosurgary. (2’ Edition) B.I. Delhi Churchill hivingstore Pvt. Ltd. Delhi, 2001;1:497-509
  8. Tuli SM., Treatment of neurological complications in tuberculosis of the spine. J. Bone Joint Surg. 1969;51A:680-92
  9. Alici, E., Akcali, 0.,Tatari, H., Gunal, I., Effect of pre- operative chemotherapy on the outcome of surgical treatment of vertebral tuberculosis : retrospective analysis of 434 cases, Arch Orthop Trauma Surg 200l;121(12): 65-6
  10. Konstam PG. Spinal tuberculosis in Nigeria. Ann R Coil SurgEngl 196;32:99-114
  11. Kohli SB. Radical surgical approach to spinal tuberculosis. J Bone Joint Surg 1967;49B 668-73
  12. Arct MW. Operative treatment of T.B. of the spine in old.

Corresponding Author

Dr Richa Sharma

Asst Prof Pediatrics, Deptt of paediatrics SLBS GMC Nerchowk Mandi