Evaluation of the role of computed tomography guided biopsy in effective diagnosis and management of patients with Koch’s spine in India

Abstract

Background: In the Indian population, tuberculosis and malignancy are the most common spinal pathologies. Radiological findings are often non-specific, thus non-diagnostic and fail to provide a prognostic perspective if the disease is established. Therefore, bacterial and/or histological evidence must be obtained to distinguish one infection from another or neoplasm. In this study, we evaluated the role of Computed Tomography-guided biopsy in Koch's spine by assessing diagnostic yield, the incidence of patients with drug-resistant tuberculosis, and drug sensitivity. Methods: Patients with suspected Koch's spine attending outpatient department of tertiary health care centre in India were selected for the study. Data were collected using proforma containing demographic, clinical, radiological and other laboratory variables. In addition, biopsy samples were sent for microbiological and histopathological analysis. Patients were followed up at an interval of 3 months to one year. Results: Most patients had Lumbar vertebra involvement followed by dorsal and least with cervical spine.41.25% of cases were drug resistant. In resistant cases, Isoniazid resistance is more seen, followed by Rifampicin. The clinical assessment revealed a significant difference in fever, back pain, Weight WBC count, Erythrocyte Sedimentation Rate and C Reactive Protein post-biopsy and treatment. Conclusions: Patients with Koch's spine should have tissue sampling for diagnosis and drug sensitivity; otherwise, they will not receive adequate treatment, leading to delayed recovery, disease worsening and resistance. Computed tomography guided biopsy thus helps early diagnosis and guides to proper anti-tuberculous treatment. In addition, it helps to decrease the burden of morbidity associated with Koch's spine.