title: Non-surgical management of cord compression in tuberculosis: a series of surprises.
abstract: METHODS
  Prospective study.
  
  
  OBJECTIVE
  We present a series of 50 patients with tuberculous cord compression who were offered systematic non-surgical treatment, and thereby, the author proposes that clinico-radiological soft tissue cord compression is not an emergency indication for surgery.
  
  
  BACKGROUND
  Spinal cord compression whether clinical or radiological has usually been believed to be an indication for emergency surgery in spinal tuberculosis.
  
  
  METHODS
  Fifty adults were prospectively studied at our clinic for spinal cord compression due to tuberculous spondylitis, between May 1993 and July 2002. The inclusion criteria were cases with clinical and/or radiological evidence of cord compression (documented soft tissue effacement of the cord with complete obliteration of the thecal sac at that level on magnetic resonance imaging scan). Exclusion criteria were lesions below the conus level, presence of bony compression, severe or progressive neurological deficit (<than Frankel grade C) and children below the age of maturity. All patients were treated with a fixed, methodically applied non-surgical protocol including hospital admission, antitubercular medications, baseline somatosensory evoked potentials and a regular clinico-radiological follow-up.
  
  
  RESULTS
  At the time of presentation, 10 patients had a motor deficit, 18 had clinically detectable hyper-reflexia and 22 had normal neurology. Forty-seven of the 50 patients responded completely to non-operative treatment and healed with no residual neurological deficit. Three patients with progressive neurological deficit while on treatment were operated on with eventual excellent recovery.
  
  
  CONCLUSIONS
  Radiological evidence of cord compression and early neurological signs need not be an emergency surgical indication in the management of spinal tuberculosis.
authors: Division of Spine Surgery, Department of Orthopaedics, PD Hinduja National Hospital and Medical Research Centre, Mumbai, India.
authors: Sanganagouda Shivanagouda
authors: SS
authors: Patil
authors: Division of Spine Surgery, Department of Orthopaedics, PD Hinduja National Hospital and Medical Research Centre, Mumbai, India.
authors: Sheetal
authors: S
authors: Mohite
authors: Division of Spine Surgery, Department of Orthopaedics, PD Hinduja National Hospital and Medical Research Centre, Mumbai, India.
authors: Raghuprasad
authors: R
authors: Varma
authors: Division of Spine Surgery, Department of Orthopaedics, PD Hinduja National Hospital and Medical Research Centre, Mumbai, India.
authors: Shekhar Y
authors: SY
authors: Bhojraj
authors: Division of Spine Surgery, Department of Orthopaedics, PD Hinduja National Hospital and Medical Research Centre, Mumbai, India.
authors: Abhay Madhusudan
authors: AM
authors: Nene
keywords: Non-surgical management; Spinal cord compression; Spinal tuberculosis