Spinal tuberculosis; A study of the disease pattern, diagnosis and outcome of medical management in Sri Lanka.

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.