ORIGINAL ARTICLE   

Minerva Ortopedica e Traumatologica 2019 September;70(3):132-6

DOI: 10.23736/S0394-3410.19.03921-3

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

The treatment of spinal tuberculosis: a single center experience

Massimo GIRARDO ¹, Alessandro RAVA ² ✉, Alessandro APRATO ², Alessandro MASSÈ ², Luigi SABATINI ², Federico FUSINI ²

¹ Unit of Spine Surgery, Department of Orthopedic and Traumatology, Orthopedic and Trauma Center, Città della Salute e della Scienza di Torino, Turin, Italy; ² Department of Orthopedic and Traumatology, Orthopedic and Trauma Center, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy

BACKGROUND: The objective of this study was to analyze the presentation, risk factors, conservative and surgical management, and outcome of spinal tuberculosis infection in adults.
METHODS: We performed a retrospective review of 65 patients (29 women and 36 men) of spinal tuberculosis infection presenting over a 10-year (2001-2011) to the Spine Surgery Department of our institution. The medical records, radiologic imaging, bacteriology results, treatment and complications of all patients were reviewed.
RESULTS: Mean age at presentation was 46 years (range 32-68 years), the mean follow-up duration was 12 months. The most common site of infection was lumbar spine (36 cases), followed by the thoracic spine (28 cases) and cervical spine (1 case). Most patients were symptomatic for between 4 and 10 weeks before presenting to hospital. Percutaneous biopsies were diagnostic in 10 patients. The patients were managed by conservative measures alone, including antibiotic therapy and spinal bracing. The mean period of antibiotic therapy was 14 months (range 12-18 months). Fifty-three patients had a supportive spinal brace for mean 12 months; 12 patients were treated with spinal cast for 8 weeks (range 6-10 weeks). The duration of the administration of oral antibiotics was depend upon clinical and laboratory evidence (white cell count, erythrocyte sedimentation rate, C-reactive protein) that the infection was resolved. The follow-up MR gadolinium scan was essential to monitor the response to medical treatment. 7 patients with active spinal tuberculosis were treated by posterior vertebral fusion and decompression. Neurological assessment was done using the Frankel scale.
CONCLUSIONS: Medical and surgical therapy are effective in TB treatment. Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. With early diagnosis and early treatment, prognosis is generally good.

KEY WORDS: Spondylitis; Discitis; Tuberculosis; Spine