Duration of antituberculosis chemotherapy in conjunction with radical surgery in the management of spinal tuberculosis

Study Design. The effectiveness of duration of anti-tuberculous chemotherapy in conjunction with radical surgery for tuberculosis of the spine is reported. One hundred fourteen patients were followed prospectively for a mean period of 14.6 years after radical resection of the tuberculous lesion and reconstruction of the resultant gap with bone graft. Objective. To evaluate the efficacy of short-course antituberculous chemotherapy in relation to the standard 18-month chemotherapy in conjunction with radical surgery for tuberculosis of the spine. Summary of Background Data. One hundred fourteen patients who Were Subjects of the Medical Research Council's (London, UK) prospective study under went radical resection of the lesion and anterior arthrodesis of the spine. These patients received 6, 9, and 18 months of antituberculous chemotherapy. Those who received 6- and 9-month chemotherapy received streptomycin, rifampicin, and isoniazid. Streptomycin was given for the first 3 months, and the other two drugs were continued for 6 or 9 months. Those who a were received 18 months of chemotherapy were given streptomycin (first 3 months), sodium para-aminosalicylic acid, and isoniazid. Methods. These patients were followed longitudinally, and at each visit, clinical and radiologic data were collected at 1-month intervals up to 3 months postoperatively, at 3-month intervals to 30 months postoperatively, at 6-month intervals up to 5 years postoperatively, and at 12-month intervals to the conclusion of study (minimum, 10 years). For assessment of spinal deformity, the ''deformity angle'' was measured on lateral spinal radiographs obtained at each visit. Results. Six-month, 9-month, and 18-month chemotherapeutic regimens in association with radical surgery produced similar clinical results with no recurrence or reactivation of tuberculosis. The changes in deformity angles at final follow-up evaluation compared with 6-month postoperative values were not statistically significantly different in the groups who underwent 6 months 9 months, and 18 months of chemotherapy. Conclusions. The authors' findings show that a 6-month chemotherapeutic regimen combined with surgical excision and bone grafting is adequate for management of tuberculosis of the spine, as it produced clinical and radiologic results comparable with the 18-month chemotherapeutic regimen.