Conservative Management of Thoracolumbar Spinal Tuberculosis in The Tertiary Care Hospital of India

Abstract

Introduction: Spinal tuberculosis is a leading cause of non-traumatic paraplegia in a developing country like India. There is an emerging trend to operate on patients early with spinal TB. A study aim was to reiterate the importance of conservative management in Spinal Tuberculosis. The study aim was to assess the clinical and radiological outcomes of the conservative management of thoracolumbar spine tuberculosis and reiterate the importance of conservative management. Methods: A prospective study with 188 thoracolumbar tuberculosis patients included from May 2016 to April 2019. All the patients were subjected to computed tomography-guided biopsy followed by anti-tuberculous therapy (ATT) for 12-months. Indications for surgery included patients in which biopsy either failed and persistent/worsening of neurology. Preoperative and postoperative clinical and functional outcomes Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and ASIA scale were measured. Results: 160 patients had a neurological deficit of ASIA-C and ASIA-D in 28. A failed performed biopsy was in 18 patients. Out of 170 successful biopsies,18 patients had persistent/worsening of neurology, these 18 (10.58%) patients required surgery. VAS was significantly improved from mean value preoperative 7.90±0.60 to 4.0±0.54 postoperative 1 month and 2.90±0.54 at the final follow?up. ODI was improved from mean value preoperative 77.10±6.90 to 30.50±6.50 postoperative 1 month and 21.30±6.70 at final follow?up. Pre-treatment mean kyphosis was 5.68±3.84 that improved to 6.51±3.88 post-treatment. Conclusions: The results of conservative treatment consisting of biopsy and ATT for at least 12 months in compliant patients are excellent. A combined approach using clinical staging, biopsy, and ATT can minimize surgical intervention in most patients. Early diagnosis and early treatment lead to a good prognosis. Periodic evaluation is a must to look for evidence of improvement and the adverse effect of ATT. Keyw