Should MRI be used to determine the duration of treatment in spinal tuberculosis?

Abstract

Background: Spinal TB (sTB) incidence is increasing globally, often presenting at a late stage with neurological morbidity; spinal MRI is increasingly used to monitor disease progression. National guidelines recommend 6 months of chemotherapy, however optimal treatment duration is unclear. Aims: To investigate presenting symptoms, treatment duration and role of spinal MRI in management of patients with sTB attending a tertiary referral centre. Methods and Results: Clinical records of 48 patients with sTB were studied retrospectively from 2007-2014. Mean age of onset was 38.6 years, mean symptom duration before diagnosis 9.8 months; most of the delay (8.5 months) was due to late referral. Mean treatment duration was 10.5 months; there was no correlation between number of vertebral lesions and treatment duration(p=0.9270). 98% of patients had a spinal MRI scan; 2.7 repeat scans were performed/person. MRI scans often corresponded to patients' symptoms – 67% of patients reported symptoms after 6 months of therapy and 22% at the end of treatment; MRI showed spinal abnormalities in 87% and 16% respectively. Conclusions: Education to increase awareness of sTB symptoms may reduce delay in diagnosis. Treatment duration is often guided by MRI and was frequently longer than recommended by current guidelines. Further guidance in the use of MRI in sTB management is needed. . | | Number(%) | || | Sex | Male: 30(63) | | Origin | UK: 6(15) | Africa: 20(52) | Asia: 10(26) | Other: 3(7) | | Time in UK(years) | ≤5: 9(38) | >5: 15(62) | | Symptoms | Back pain: 43(90) | Constitutional: 24(50) | Neurological: 24(50) | | Vertebral region | Cervical: 2(4) | Thoracic: 9(19) | Lumbar: 16(34) | Sacral: 3(6) | >1 region: 17(36) | | Treatment length(months) | ≤6: 7(15) | 6-9: 11(23) | >9: 30(62) | Cohort demographics