Defining the end point of drug therapy in tuberculosis of spine: Analysis of 76 cases in a tertiary care centre

Abstract

Abstract Background: The duration of chemotherapy for the tubercular spine is an unresolved issue. Various drug regimens have been used for various durations. Objectives: (1) To calculate the duration of antitubercular therapy (ATT) for achieving the healed status of the tubercular spine, (2) to report the behavior of kyphotic deformity, and (3) outcome of neurological deficit. Materials and Methods: This longitudinal descriptive study included 76 cases of tubercular spine diagnosed on clinico-imaging and/or on histopathology/molecular tests. They were treated as per the DOTS regime. Surgery was done for predetermined indications. ATT was stopped once healed status was demonstrated on CE-MRI/PET-CT. Kyphotic deformity was measured by modified Konstam’s method, and neurological grading was assessed by Tuli’s grading. Results: The mean duration of healing was 20.08 ± 8.09 months (range 9–48 months) in primary spinal TB with no recurrence after the mean follow-up of 15 months (range 3–108 months). Overall, 92.6% showed good neural outcomes at the final follow-up. Mean kyphotic deformity was found to be 16.75° ± 12.23°, 18.78° ± 12.62°, and 18.78° ± 12.53° at presentation, after stopping ATT and at the final follow-up. Conclusion: It is unscientific to stop ATT in spinal TB till healed status is demonstrated by contrast-enhanced MRI or PET-CT. Although the sample size is small, the data is enough to prove this point that if all patients were treated till healed status was achieved, there would be no recurrence.