Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Outcome and Management of Spinal Tuberculosis According to the Severity of Disease: A Retrospective Study of 137 Adult Patients at Korean Teaching Hospitals

Park, Dae Won, MD, PhD*; Sohn, Jang Wook, MD, PhD*; Kim, Eung-Ha, MD, PhD; Cho, Dong-Il, MD, PhD; Lee, Jung-Hee, MD, PhD§; Kim, Ki-Tack, MD, PhD§; Ha, Kee-Yong, MD, PhD; Jeon, Chang-Hoon, MD, PhD; Shim, Dae-Moo, MD, PhD#; Lee, Jin-Soo, MD**; Lee, Jang-Bo, MD, PhD††; Chun, Byung Chul, MD, PhD‡‡; Kim, Min Ja, MD, PhD*

doi: 10.1097/01.brs.0000255216.54085.21
Clinical Case Series
Buy

Study Design. A retrospective study examining the clinical features, management, and treatment outcome of patients with spinal tuberculosis (TB).

Objective. To determine the influence of disease severity and treatment modality on outcome of patients with spinal TB.

Summary of Background Data. Although anti-TB chemotherapy is now the mainstay treatment for spinal TB, it may not be applicable to all situations, especially in patients with risk of deformity, instability, and progression of neurologic deficit.

Methods. In this retrospective study (1994–2003), medical records and radiographic findings of patients with spinal TB were reviewed at 7 teaching hospitals in South Korea. The duration of triple chemotherapy with isoniazid, rifampin, and ethambutol, disease severity, operative procedures, and outcome were analyzed. The outcome was assessed as both favorable and unfavorable according to predefined criteria.

Results. A total of 137 patients were diagnosed with spinal TB during the study period. Twenty-one patients were lost to follow-up and excluded from analysis. The mean age was 44.07 ± 16.57 years. The most common vertebral area involved was the lumbar (44.8%). The mean number of vertebra involved was 2.25. The mean angle of kyphosis was 21.58°. Forty-seven patients (35.1%) had severe symptoms. Radical surgery was carried out in 84 (62.2%) patients. Twenty patients were treated with short-term chemotherapy, while 96 under long-term. At the end of chemotherapy, 94 patients had achieved a favorable status and 22 an unfavorable one. Statistically, there was no significant difference between the 2 groups in terms of gender, chemotherapy duration, or the severity of spinal TB; however, age (P = 0.025; odds ratio = 0.963; 95% confidence interval 0.932–0.995) and radical surgery (P = 0.043; odds ratio = 3.047; 95% confidence interval 1.038–8.942) were significantly related to a favorable outcome by logistic analysis.

Conclusions. Our results showed that a younger age and radical surgery in conjunction with anti-TB chemotherapy were significant favorable prognostic factors.

This retrospective study investigated spinal tuberculosis, and its outcome and relationship to severity, chemotherapy duration, and surgical approach. Younger age and a radical surgery were significantly related to a favorable outcome; however, the duration of chemotherapy was not.

From the Departments of *Internal Medicine, College of Medicine, Korea University, Seoul; †Orthopedic Surgery, Soonchunhyang University, Bucheon Hospital, Gyeonggi; ‡Chest Medicine, National Medical Center, Seoul; §Orthopedic Surgery, College of Medicine, Kyunghee Medical Center, Seoul; ∥Orthopedic Surgery, The Catholic University of Korea, Kang-Nam St. Mary Hospital, Seoul; ¶Orthopedic Surgery, Ajou University Hospital, Gyeonggi; #Orthopedic Surgery, WonKwang University Hospital, Jeolla; **Internal Medicine, Inha University Hospital, InCheon; ††Neurosurgery, Korea University, College of Medicine, Seoul; and ‡‡Preventive Medicine, College of Medicine, Korea University, Seoul.

Acknowledgment date: April 5, 2006. First revision date: August 19, 2006. Second revision date: September 25, 2006. Acceptance date: September 25, 2006.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Federal funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Min Ja Kim, MD, PhD, Professor, Division of Infectious Diseases, Department of Internal Medicine, Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5th Street, Seongbuk-gu, Seoul, 136-705, South Korea; E-mail: macropha@korea.ac.kr

© 2007 Lippincott Williams & Wilkins, Inc.