Spinal tuberculosis; A study of the disease pattern, diagnosis and outcome of medical management in Sri Lanka.
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Date
2013-10
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Abstract
Background: Sri Lanka has an intermediate burden of tuberculous disease. Most patients with spinal tuberculosis (STB) are
managed with medical treatment alone as advanced surgical facilities are not freely available.
Objective: To describe the clinico-demographic and imaging pattern of STB and to assess the outcome of medical treatment in
the local setting.
Design: Descriptive case series.
Methods: All patients diagnosed with definite or probable STB, had their symptomatology and investigations recorded. They
were followed up with anti-TB treatment (ATT) according to standard guidelines. An initial six-week tapering course of steroid
was given when there was an evidence of neural involvement.
Results: Of 32 patients with STB, backache was the commonest presenting feature (92%). Nine had lower limb neurological
deficits. Uni-focal upper lumbar involvement was the commonest disease pattern noted in the series. High ESR (84%) and
Mantoux positivity (53%) were frequent. 72% had end-plate changes on imaging. 53% had paraspinal soft tissue components.
The triad of backache, high ESR and end-plate and/or paraspinal disease on CT/MRI showed a diagnostic sensitivity of 81.2%.
Response to ATT was satisfactory in 87%. Poor neurological response was seen among some with large paraspinal collections
or extensive vertebral damage at diagnosis.
Conclusion: This study showed that backache over one month, high ESR and specific CT/MRI features helped diagnosis of STB, in the
absence of definitive evidence. Medical management alone, comprising a prolonged course of ATT with an initial steroid cover when
indicated, appeared to be safe and effective in the local setting for uncomplicated STB.
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Keywords
Tuberculous spondylitis, Pott’s disease, Outcome
Citation
Yasaratne B M G D, Wijesinghe S N R, Madegedara R M D. Spinal tuberculosis; A study of the disease pattern, diagnosis and outcome of medical management in Sri Lanka. Indian Journal of Tuberculosis. 2013 Oct; 60(4): 208-216.