Spinal tuberculosis; A study of the disease pattern, diagnosis and outcome of medical management in Sri Lanka.
Article
in English
| IMSEAR
| ID: sea-159972
ABSTRACT
Background:
Sri Lanka has an intermediate burden of tuberculous disease. Most patients with spinal tuberculosis (STB) are managed with medical treatment alone as advanced surgical facilities are not freely available.Objective:
To describe the clinico-demographic and imaging pattern of STB and to assess the outcome of medical treatment in the local setting.Design:
Descriptive case series.Methods:
All patients diagnosed with definite or probable STB, had their symptomatology and investigations recorded. They were followed up with anti-TB treatment (ATT) according to standard guidelines. An initial six-week tapering course of steroid was given when there was an evidence of neural involvement.Results:
Of 32 patients with STB, backache was the commonest presenting feature (92%). Nine had lower limb neurological deficits. Uni-focal upper lumbar involvement was the commonest disease pattern noted in the series. High ESR (84%) and Mantoux positivity (53%) were frequent. 72% had end-plate changes on imaging. 53% had paraspinal soft tissue components. The triad of backache, high ESR and end-plate and/or paraspinal disease on CT/MRI showed a diagnostic sensitivity of 81.2%. Response to ATT was satisfactory in 87%. Poor neurological response was seen among some with large paraspinal collections or extensive vertebral damage at diagnosis.Conclusion:
This study showed that backache over one month, high ESR and specific CT/MRI features helped diagnosis of STB, in the absence of definitive evidence. Medical management alone, comprising a prolonged course of ATT with an initial steroid cover when indicated, appeared to be safe and effective in the local setting for uncomplicated STB.
Full text:
Available
Index:
IMSEAR (South-East Asia)
Main subject:
Sri Lanka
/
Tuberculosis, Spinal
/
Female
/
Humans
/
Male
/
Child
/
Adolescent
/
Treatment Outcome
/
Adult
/
Young Adult
Type of study:
Diagnostic study
/
Practice guideline
Country/Region as subject:
Asia
Language:
English
Year:
2013
Type:
Article
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