A Prospective Study to Assess Efficacy of Directly Observed Treatment Short Course Intermittent Regimen in Different Stages of Spinal Tuberculosis

Abstract

Introduction Management of tuberculosis spine still possesses many challenges. Availability of antitubercular 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 Program (RNTCP) regime based on DOTS strategy from January 2011 to June 2014 to evaluate the efficacy and to come to a conclusion regarding optimum duration of treatment. Patients and Methods A prospective study of 60 consecutive patients of spinal tuberculosis treated with Category I RNTCP based on DOTS strategy. All the patients were followed for a minimum of 1 year. Surgical intervention was done in patients presenting with significant neurological deficits. Patients diagnosed clinicoradiologically and histopathologically ( n = 8) were enrolled in the study. The 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 like a return to normal bone density and sclerosis, bony ankylosis, and disappearance of marrow edema on MRI. Results In 60 cases, 63.4% ( n = 34) males and 36.7% ( n = 26) females. Overall, 10% ( n = 6) were with predestructive lesion, 53.3% ( n = 32) were in the early destructive phase, 30% ( n = 18) with mild angular kyphosis and 6.67% ( n = 4) with moderate angular kyphosis. Outcome of our study were excellent in 46.67% ( n = 28), good in 36.67% ( n = 22), fair in 10% ( n = 6), and poor in 6.67% ( n = 4). Duration to cure spinal tuberculosis 6 months 30% ( n = 18), 9 months 56.67% ( n = 34), and 12 months 13.33% ( n = 8). Conclusion The duration of treatment for cure of spinal tuberculosis was 100% ( n = 6) in predestructive and 37.5% ( n = 12) in early destructive phases was 6 months, 62.5% ( n = 20) early destructive, and 77.76% ( n = 14) mild kyphotic phases were 9 months and 22.2% ( n = 4) mild destructive and 100% ( n = 4) moderate kyphotic phases was 12 months. Favorable outcome and short duration of chemotherapy is needed in patients treated early.