ABSTRACT

Background Data:

Tuberculosis (TB) is the most common granulomatous infection of the spine. Its prevalence is rising due to higher number of immune suppressed individuals and increased drug resistance. Chemotherapeutic agents remain cornerstone of treatment. Surgery is indicated when anti-tuberculosis therapy (ATT) fails, neurological deficit or deformity occur. Lumbar involvement is relatively rare and its unique anatomical and properties yield a more favorable outcome.

Purpose:

To evaluate 10 years clinical outcome of patients with TB of the lumbar spine who had undergone surgery combined with short-course (9 months) two drug ATT .

Patients and Methods:

Patients who were operated in our clinic and received 9 months of ATT (INH 5 mg/kg and rifampicin 10 mg/kg) between years 1993-2000 were included in our study. Patients with less than 10 years of follow-up were excluded. Preoperative, immediate post-operative and final local kyphosis angle and neurological status were analyzed.

Results:

Mean follow-up period of 8 patients was 150.3 months (130-206). Mean local kyphosis angle was -13.3º (range -8º, -18º).Mean correction was 8.9º. At the final follow-up, mean loss of correction was 3.7º (50 %), 3.3º (62 %) and 2º (12 %) degrees for anterior only, posterior only and combined surgery, respectively.

Conclusion:

Successful deformity prevention, shorter hospitalization need, good clinical outcome and early mobilization make internal instrumentation of the spine combined with ATT advantageous over bed rest and orthotics use. Effective ATT combined with proper surgical technique yields high fusion rates and favorable outcome. Anatomical properties of the lumbar spine help to maintain the lordosis.