The outcomes of chemotherapy only treatment on mild spinal tuberculosis.

Zehua Zhang,Jianzhong Xu,Fei Luo,Fei Dai,Qiang Zhou,Dong Sun

doi:10.1186/s13018-016-0385-y

Abstract

BackgroundThe treatments for spinal tuberculosis (TB) patients without absolute surgical indications have been controversial. Some people believed that most spinal TB patients were indicated for surgery, while other people believed in chemotherapy only. To help clarify the treatment over spinal TB patients without absolute surgical indications, we characterized a subtype spinal TB and then analyzed the treatment outcomes of standard chemotherapy alone.MethodsIn this retrospective study, 740 adult patients of spinal TB from January 2005 to January 2013 in our institution were reviewed. Patients who fit into the characterizations of mild spinal TB were started by standard chemotherapy for 18 months and followed up for at least 2 years upon the completion of treatment. The overall outcome, neurological function, local kyphosis, and level of pain at different time points were assessed.ResultsAfter starting the conservative treatment, 89 out of 740 patients were chosen for chemotherapy alone, and all patients were followed up for at least 2 years (ranging from 24 to 50 months) upon the completion of the treatment. Of 89 patients, 95.4 % of patients showed a definite and clinical response within 1 month after starting the treatment, 69 % of patients had excellent to good results, with no complications of the disease, and 77.5 % had asymptomatic local kyphosis with intact neurological function; solid bony fusion of adjacent segment was achieved in 88.8 % of patients.ConclusionsWe believe that the mild spinal TB respond well to the standard chemotherapy, and the detailed description of mild TB would provide crucial guidance in determination of conservative treatment.

Highlights

The treatments for spinal tuberculosis (TB) patients without absolute surgical indications have been controversial
Patients who met all the above criteria were treated conservatively, and patients with deteriorating neurologic function or progressive kyphosis while on anti-tuberculosis chemotherapy were considered for surgical treatments
After starting the conservative treatment, 89 out of 740 patients were chosen for chemotherapy alone, and all patients were followed up for at least 2 years upon the completion of the treatment

Summary

Introduction

The treatments for spinal tuberculosis (TB) patients without absolute surgical indications have been controversial. To help clarify the treatment over spinal TB patients without absolute surgical indications, we characterized a subtype spinal TB and analyzed the treatment outcomes of standard chemotherapy alone. The absolute surgical indications for spinal TB include (1) progressive neurologic deficit, (2) progressive increase in spinal deformity (coronal or sagittal) (3) failed conservative treatment including 1 and 2 above or severe pain due to abscess or spinal instability, and (4) uncertain diagnosis: this could. The treatment of tuberculosis is by chemotherapy and surgery attempts only to extirpate the complications arising from the disease process. Most cases of spinal TB merit medical rather than surgical treatment, especially the mild spinal TB.

Methods

Results

Discussion

Conclusion