Conservative Treatment of Tuberculosis of the Spine

Moon, Myung Sang; Woo, Young Kyun; Park, Young Ou

Abstract

Tuberculosis of the spine is still prevalent in many parts of the world and still remains as an important orthopaedic problem in Korea. Moreover, spinal tuberculosis is the most common and dangerous form of skeletal tuberculosis. With the availability of very effective antituberculous drugs two divergent controversy in the management of tuberculosis of the spine have been reported. A large group of surgeons has advocated the radical excision of the tuberculous focus and replacement of the defect with autogenous bone grafts under cover of chemo-therapy, and another practise is typified by regimen of Friedman, Konstam, Kaplan, and Stevenson and Manning, who treated a large number of patients with spinal tuberculosis using antiuberculous drugs alone. Even now, because of the shortage of hospital beds and ancillary help, private poor economy and patients general condition, some group of patient with tuberclous spine have been treated conservatively using effective antituberculous drugs. In this study authors clinically analysed the 75 patients who had conservative treatment with triple drug therapy for 18 months at the department of Orthopaedics, Catholic Medical College and Center during the past 10 years, and the results were as follows: 1. There were two prevalent age groups. One is the first decade (30.6%) and the other is the third decade(30.7%). The age prevalence in children was 6 to 10 years of age. 2. The lesions were common in the lumbar spine(56.0%) and the most commonly involved vertebra was L3. The average initial number of involved vertebral body was 1.9 vertebrae and it was changed to 2.3 vertebrae at the end of treatment(18 months). 3. Active pulmonary foci was associated in 17.4%(6.7% of tuberculous pleurisy included). 4. Out of 75 cases twenty-six(34.7%) had new involvement at the adjacent vertebra within 18 months after treatment. 5. The radiographic activity was assessed as active in all cases initially, but at 18 months after treatment 83% of the cases were in quiescent condition, and this percentage was increased to 78.7% at 36 months. 6. Spontaneous fusion rate of involved vertebral bodies was 24% at 18 months and 36% at 36 months after treatment, respectively. 7. Radiologically observed deep seated abscess shadow disappeared slowly over 3 to 20 months, but this disappearance was observed mainly within 8 months after treatment. 8. Mean increment of the kyphosis was average 7.5 degree (9.3° in children and 6.6° in adults) at the end of the treatment(18 months), and average 8.6 degree(10.9° in children and 7.3° in adults) at 36 months, by. internal gibbus angle. 9. Almost in all the adult patients, kyphosis developed during the active phase of the disease, while in children kyphosis progressed even after the healing of the disease. Children who had multiple vertebral involvement at the dorsal area had a tendency to develop more severe kyphosis. 10. Decrement of the kyphosis angle which located at the lumbar area after the end of the treatment was considered to be an effect of narmal lordotic curvature. 11. Generally representation of the changes seen in children was almost osteolytic change without sequestrum in comparison to adults who had more sequestrum formation. 12. In 95% of cases a favourable results were obtained.