TUBERCULOSIS OF SPINE: CLINICO-RADIOLOGICAL OUTCOMES , COHORT STUDY IN A TERTIARY CENTER

Abstract

Background: Tuberculosis of the spine is one of the most common spine pathology in developing nations. This study highlights the special considerations that need to be taken into account while tackling the diagnostic and therapeutic challenges posed by this disease. Materials And Methods: A cohort of patients (n=32) diagnosed and treated as TB spine were included in the study. Among 32 patients, 17 (53.1%) were manged conservatively with anti-tubercular therapy (ATT), 15 (46.8%) were manged with surgical intervention + ATT. Patients were followed up with serial ESR, CRP, Liver function test (LFT), plain radiographs at regular intervals of 2months, 3months, 6months, 9months and 12 months. Functional outcome on Japanese orthopaedic association (JOA) scale and pain assessment with Visual analogue score (VAS) were documented at each visit. Assessment of fusion at the operated level was done by Bridwell classication in surgically managed patients. Results: Thoracic spine (n=13) was the most common site of involvement followed by the thoracolumbar (n=4), lumbar (n=10) and lumbosacral (n=5) region. 18 (56.2%) patients had signicant neurological decits (11-motor and 7 -sensory) at presentation. On laboratory work up, the mean CRP and ESR values at presentation were 4.43 ± 5.18 mg/dl and 51.75 ± 25.54 mm/hr respectively. Focal kyphosis was noted in 14 (40.3%) patients with a mean kyphosis of 26.330(+/- 6.70). There was steady improvement in the JOA scores accompanied by a decline in the VAS score at subsequent follow ups. There was no signicant difference between the conservative and surgical group at nal follow up. Conclusion: Early diagnosis of tuberculous affection of spine is challenging and requires high index of suspicion. Timely diagnosis and prompt treatment is necessary to prevent neurological complications and to minimize spinal deformity.