Radiological and clinical outcome of conservative management of thoracolumbar spinal tuberculosis in adults

Abstract

Introduction: Potts disease continues to be a major health problem in developing and underdeveloped countries. Patients who exhibit both kyphotic deformity and minimal neurological impairment and can be managed conservatively which may be achieved by chemotherapy alone, surgical indications in these patients are specific and few. Since the last decade there is paucity of literature regarding the conservative management of thoraco-lumbar spinal tuberculosis with increasing trend toward more and more surgical management. Method: This study was done between January 2018 and June 2019, patients with age >18 years with thoraco-lumbar spinal tuberculosis were studied. Relevant X-rays, Mri, Esr, Crp, Vas (Visual Analog Score) and ODI (Owestry Disability Index) was done. Changes in kyphotic angles pre and post op were calculated in lateral views of pain radiographs of dorsolumbar spine via Cobb's method. Results: All patients judiciously completed the scheduled course of ATT. The highly significant reduction in ESR and CRP was found after 1 st visit, 2 nd visit and final visit relative to before treatment (p<0.001 for each visit).On the basis of ODI category changes, significant improvement was found after the treatment (p<0.001), before treatment 20% cases were belonging to the severe category, while only 35% were belonging to the minimal category but at post treatment, minimal proportion was increased to 85% while severe was eliminated fully. The Vas scores improved dramatically with increase in kyphotic angle. Conclusion: MRI gains the role of a pivoting stone in non-invasively diagnosing spinal tuberculosis as the gold standard investigation. The old regime of 18 months of ATT is not valid nowadays and just a meticulously applied 6-12 months of ATT is sufficient to achieve cure of spinal tuberculosis. Judiciously applied conservative management may certainly give exceedingly good results.

Tuberculous osteomyelitis of OS Calcis

“…The radiographic highlights of osteoarticular tuberculosis are vague [2,3,10] . Radiographic findings are normally noted 2-5 months after the start of illness and just a joint effusion might be evident in the beginning phase [11,12] . The typical radiographic presentation of tuberculous arthritis is portrayed by juxta-articular osteoporosis, peripheral osseous erosions and steady decrease of joint space, known as the Phemister triad [11,12] , is not a common entity in calcaneum.…”

“…Radiographic findings are normally noted 2-5 months after the start of illness and just a joint effusion might be evident in the beginning phase [11,12] . The typical radiographic presentation of tuberculous arthritis is portrayed by juxta-articular osteoporosis, peripheral osseous erosions and steady decrease of joint space, known as the Phemister triad [11,12] , is not a common entity in calcaneum. Lytic territories of destruction and minor erosions are regularly observed along the articular edges in weight-bearing articulations such as the hip, knee and ankle [12] .…”

“…The typical radiographic presentation of tuberculous arthritis is portrayed by juxta-articular osteoporosis, peripheral osseous erosions and steady decrease of joint space, known as the Phemister triad [11,12] , is not a common entity in calcaneum. Lytic territories of destruction and minor erosions are regularly observed along the articular edges in weight-bearing articulations such as the hip, knee and ankle [12] . In any case, as opposed to the pyogenic arthritis, there is relative protection of joint space in early stages of the disease attributable to the absence of proteolytic enzymes in the exudate.…”

“…Extreme osteopenia is distinctively noted, and particularly in adults, there is an absence of sclerosis or periostitis in the beginning phase when the infection is dynamic. Serious joint destruction and, in the long run, sclerosis and fibrous ankylosis are noted in the late stages when dynamic infection has settled [1,11,12] . Advanced imaging is more dependable on detecting the disease early and helps in surgical planning.…”

Calcaneum tuberculosis – A rare entity: Case report and review of literature

“…Second, the Phemister triad (peripheral bony erosion, decreased joint space and juxta-articular osteoporosis), is not commonly seen in calcaneal TB. [10,26] Dhillon et al [7] study on foot TB showed that out of 92 cases, the cystic form was seen in 24 cases. In contrast, a study by Mittal et al [15] showed the presence of the cystic form in only 15 cases out of 44.…”