Manoj Kumar H. V1, Somashekara S. A2, Shivaraj N3, Abhijit Patil4, Suresh M5
STUDY DESIGN: A Prospective non-randomised study
INTRODUCTION: Management of Tuberculosis spine still possesses many challenges. Availability of anti- tubercular drugs has changed the outcome. However, present recommendation by the WHO of Directly Observed Treatment Short-course (DOTS) has sound scientific basis, but the optimum duration is still controversial. We conducted a prospective study on a consecutive series of patients with spinal tuberculosis treated with Category I Revised National Tuberculosis Control Programme (RNTCP) regime based on DOTS strategy from June 2012 to Sep 2014 to evaluate the efficacy and come to conclusion regarding optimum duration of treatment
MATERIALS AND METHODS: A prospective study of 30 consecutive patients of spinal tuberculosis treated with Category I RNTCP based on DOTS strategy. All the patients were followed for minimum of 2 year. Surgical intervention was done in patients presenting with significant neurological deficits. Patients diagnosed clinicoradiologically and histopathologically (n=3) were enrolled in the study. Outcome was graded into excellent, good, fair and poor based on clinical, laboratory including return of ESR to normal and correction of lymphocytosis and radiological outcome showing - return to normal bone density and sclerosis, bony ankylosis and disappearance of marrow edema on MRI
RESULTS: In 30 cases, 63.4% (n=19) were males and 36.7% (n=11) were females. 10% (n=3) were with pre-destructive lesion, 53.3% (n=16) were in the early destructive phase, 30% (n=9) with mild angular kyphosis and 6.67% (n=2) with moderate angular kyphosis. Outcome of our study were excellent in 46.67% (n=14), good in 36.67% (n=11), fair in 10% (n=3) and poor in 6.67% (n=2). Duration to cure spinal TB 6 months 30% (n=9), 9 months 56.67% (n=17) and 12months 13.33% (n=4).
CONCLUSIONS: Outcome of our study were excellent in 46.67% (n=14), good in 36.67% (n=11), fair in 10% (n=3) and poor in 6.67% (n=2). The duration of treatment for cure of spinal TB in 100% (n=3) pre-destructive and 37.5% (n=6) early destructive phases was 6 months, 62.5% (n=10) early destructive and 77.76% (n=7) mild kyphotic phases was 9 months and 22.2% (n=2) mild destructive and 100% (n=2) moderate kyphotic phases was 12 months. Favourable outcome and short duration of chemotherapy is adequate in patients treated early.