A Prospective Descriptive Cohort study Analysing the Clinical, Radiological and Functional Outcomes of all Patients with Tuberculosis of the Thoracolumbar Spine Treated both Conservatively and Surgically

OBJECTIVES OF THE STUDY: To assess the clinical and radiological outcomes in all patients with and without neurological deficits who were managed conservatively or surgically and indications for mode of treatment. METHODS: Patients in this study were retrospectively and prospectively assessed for their clinical, radiological and functional outcomes in all who were managed conservatively or surgically for thoracolumbar junction TB from January 2006 to June 2018. Patients were graded based on their VAS score, Cobb’s, kyphotic angle and MacNabs criteria at each follow up at 9 months,9 months – 24 months, 24 months-60 months and more than 60 months to assess their clinical, radiological and functional outcome. Descriptives were given using mean +/- standard deviation for continuous variable and frequency along with percentage for categorical variable. The incidence of outcome i.e. neurological deficits is presented with 95% confidence interval. RESULTS: This study showed that in patients with thoracolumbar junction involvement on the 9 month ATT regimen, the patients being managed surgically had a better resolution of symptoms, pain and return to function than those conservatively managed, though final results were similar. This study also showed that more than two level vertebral unit involvement was better managed surgically for early rehabilitation .This study also showed that the mean final Cobb’s angle in the surgically treated patients was lower than that in the conservative group and was statistically significant though final VAS score and Macnabs were not affected in both groups. CONCLUSIONS: This study concluded that patients with a single vertebral functional unit involvement are better managed conservatively and patients with multiple vertebral functional unit involvement are better managed surgically for early rehabilitation and better outcome, with both groups of patients showing a good clinical, radiological and functional improvement with the loss of correction being same in both groups of patients