Clinical and Radiological Evaluation of Healing In Tuberculosis of Spine-A Retrospective and Prospective Study.

ABSTRACT

Background: Tuberculosis of spine constitute nearly 1% of overall cases. Surgery is indicated in selected cases, and medical care is the key treatment. The duration of anti tubercular drug therapy in spine TB is controversial. Objective: - The purpose of this retrospective and prospective study was to see the incidence, diagnose, monitor the treatment duration and complications in patients with tuberculosis of spine. Study Design - From April 2013 to October 2014 one hundred and twenty one patients with TB of the spine were admitted and treated in our institution. Methods: The patients were carefully monitored and followed up. Those who had an indication for surgical decompression were managed accordingly. For assessment we used visual analogue scales to report the level of pain, Japanese orthopaedic association score and Nuricks grading to assess the neurological and functional improvement at initial and follow up visits. Results: Out of all 122 patients, 102 patients (84.4%) healed over varying period of time and 18 (14.8%) were still under treatment while the study ended. Neurological involvement was seen in 32 (26.3%) out of 122 patients at initial presentation in the form of sensory, motor or bladder bowel involvement. The duration of healing was measured from the start of ATT till it was stopped at healing and was found to be maximum in patients with involvement of the lumbar spine with a median healing of 16 months. The treatment was completed in 103 patients and ATT was stopped and the mean healing time was 14.5 months. Conclusion: We found that the most common involved level was at the lumbar spine and skip lesions were more common. There is no fixed criteria for the duration till which the anti-tubercular therapy has to be given. It should depend on the level and extent of spinal involvement.