Treatment modalities for tuberculosis of the spine: 22 years' experience in east Taiwan

Background: Tuberculosis (TB) remains a prevalent infectious disease in eastern Taiwan, and, tuberculous spondylitis has a great impact on the quality of daily life. Aim: To investigate the demographics, clinical manifestation and treatment in eastern Taiwan. Methods: From January 1988 to December 2010, the medical records were retrospectively reviewed of adult patients with a diagnosis of TB of the spine. Patients were enrolled with positive acid fast stain, culture results, or characteristic pathologic findings. Demographic data, clinical manifestations, and the treatments were analyzed. Results: During the period, 39 patients (24 women and 15 men) with TB of the spine were identified; the mean age was 54 years. The lumbar spine (26 patients, 63%) was the most commonly involved site, followed by the thoracic spine (20 patients, 49%). The TB spine mostly involved two vertebral segments, as noticed in 21 (51%) patients with spinal TB. There were six patients (15%) with at least five segments involved. Concomitant pulmonary TB was found in seven patients. Most patients received surgical correction plus a combination of anti-TB drugs (isoniazid, rifampin, ethambutol, pyrazinamide), and seven patients received medical treatment only because of high surgical risk. Most commonly, surgery was performed with a combination of anterior and posterior approaches. Most patients recovered well after surgery. Conclusion: Patients with TB of the spine may involve more than one spinal segment. On the basis of the four-drug combination in the initial phase followed by treatment for up to 12 months, along with appropriate surgical correction, can lead to good clinical outcomes with acceptable risks. Copyright (C) 2013, Taiwan Surgical Association. Published by Elsevier Taiwan LLC. All rights reserved.