Outcome and management of spinal tuberculosis according to the severity of disease: a retrospective study of 137 adult patients at Korean teaching hospitals.
METHODS
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.


BACKGROUND
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 degrees. 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.
Park
Dae Won
DW
Department of Internal Medicine, College of Medicine, Korea University, Seoul.
Sohn
Jang Wook
JW
Kim
Eung-Ha
EH
Cho
Dong-Il
DI
Lee
Jung-Hee
JH
Kim
Ki-Tack
KT
Ha
Kee-Yong
KY
Jeon
Chang-Hoon
CH
Shim
Dae-Moo
DM
Lee
Jin-Soo
JS
Lee
Jang-Bo
JB
Chun
Byung Chul
BC
Kim
Min Ja
MJ
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D019299:Decompression, Surgical; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000627:therapeutic use; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D007723:Korea; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use; D012720:Severity of Illness Index; D013123:Spinal Fusion; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000145:classification / Q000188:drug therapy* / Q000601:surgery*
D000995:Antitubercular Agents; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin