Spinal Tuberculosis Treated by Antituberculous Chemotherapy and Radical Operation

Abstract

Between 1956 and 1968, 208 patients with spinal tuberculosis healed by chemotherapy with and without surgical intervention. Two vertebral bodies were affected in 82 patients, one in 23 cases, more than 4 in 70 patients. Sixty-one patients had neural involvement at the time of admission, 42 of them an incomplete or complete paraplegia. All patients were treated by triple-drug chemotherapy. Chemotherapy and bed rest alone was sufficient for 76 patients. Surgical intervention was indicated in 132 cases. Debridement was carried out in 33 cases, debridement and spinal fusion was performed in 18 cases, anterolateral decompression of the spinal cord alone was employed in 15 cases, and together with spinal fusion recommended in 15 cases. Minor surgical procedures were made necessary in 8 cases. The indications for surgery were: (1) unfavorable response to conservative treatment during 3 months, (2) Pott's paraplegia showing no signs of recovery by conservative treatment, (3) Pott's paraplegia developing during conservative treatment (4) cases with unstable spinal lesions, and (5) cases with paravertebral abscesses and sinuses. Complete or good recovery occurred in 61 out of 76 conservatively treated patients. Forty-two out of 61 patients with neural involvement made a complete or a good recovery, 31 being patients with paraplegia. No improvement was noted in 16 cases with neural involvement, and 2 had progression of the neurological signs. A complete recovery was noted in 101 out of 132 operatively treated patients, a good recovery in 21, and no improvement in 9 patients with paraplegia. One patient died; 141 patients returned to their former work, 30 of whom were recovered paraplegics. Fifteen had retired because of advanced age. Modern treatment begins with triple-drug chemotherapy and bed rest for 3 months. If the response is unsatisfactory, debridement or debridement with spinal fusion is carried out as soon as possible. Anterolateral decompression is applied in cases with paraplegia.