Different Treatment Modalities for the Management of Spinal Tuberculosis

Objective: To study the rationale of different treatment modalities of caries spine, anti tuberculus therapy (ATT), abscess drainage, spinal cord decompression and stabilisation.Materials and Methods: In this descriptive study number of patients were 132 conducted in the department of neurosurgery Lady Reading Hospital, Peshawar. From Dec.2008 to Dec. 2012.Results: Local spinal pain was relieved in 98.5%, tenderness improved in 97.7%, Paresis and plegia in 81.1%, Kypotic deformity reduced in 43.2%, approved sphincter functions improved in 40.6% cases. Morbidity was 2.3% and mortality (0.8%). Surgical procedure was abscess drainage in 8% and anterior decompression and stabilization was in 61% cases. All patients were treated with standard ATT regimen 4 drugs for 2 to 3 months and 3 drugs for 10 – 16 months and analgesics and followed for 18 months. Male were 83 (62.9%), female 49 (37.1%) minimum age 3years, maximum 70 years and mean ± SD 30 ± 15 years. Inclusion criteria: Patients hav-ing spinal TB. Exclusion criteria: Spinal pyogenic infection, metastasis and metabolic bone diseases. Informed consent and ethical committee approval was taken. Diagnosis was made on history and clinical examination of local tenderness, kyphotic deformity, paraparesis / plegia, tetraparesis / plegia and sphincter dysfunction. Investi-gations were x-ray chest, spine 3D CT and MRI. Erythrocyte sedimentation rate (ESR) and biopsy of the necrotic materials were done. Patients were treated with stanandard ATT, neurological improvement and radiological stability was assessed. Patients were divided in Group – A: Only ATT or abscesses drainage and ATT. Group-B: Spinal decompression and stabilisation with ATT. All information were recorded on a proforma. Data was analyzed using SPSS version 19.Conclusions: Early diagnosis and treatment had excellent outcome. Dorso-lumbar spine involvement and young age was common. Advanced cases needs multimodal therapy (medical, surgical and supportive). Some degree of kyphotic deformity still remained