Treatment Outcomes of Spinal Tuberculosis Patients

Abstract

Introduction The diagnosis of spinal tuberculosis (TB) is often delayed, which may affect treatment outcomes. NICE Guidelines suggest to treat spinal TB for 6 months however it does not take into account severity of disease (multi-level involvement or presence of paravertebral or psoas abscesses) at presentation. Methods We conducted a retrospective study of consecutive patients attending a spinal TB clinic at a large London Hospital. Information on demographics, clinical manifestation at diagnosis, radiology and treatment outcomes were recorded. Results Seventy-four cases with Spinal TB were identified during 2010-2022. Twenty-five cases had incomplete data. Out of 49 cases, 30(61%) were male and median age was 33 years (14 IQR). Out of 49 cases 42 (85%) were migrants and 7 cases were born in the UK. Forty-six patients were HIV negative, and three patients HIV status were unknown. 36(73%) patients had no co-morbidities. 6(12%) patients had Diabetes Mellitus. Twelve (24%) cases had pulmonary TB involvement. Forty three out of 49(86%) had back or neck pain as their primary symptom at presentation. Thirty-one (63%) patients had constitutional symptoms. Four (8%) patients had spinal cord compression, two patients had paradoxical drug reactions and 17(34%) patients needed surgery/or drainage of paravertebral or psoas abscesses. All patients had MRI whole spine performed at diagnosis. 19/49 (38%) had multiple spinal level involvement. The most common level affected was the thoracic spine 35/49 (71%), followed by lumbar 25/49 (51%), cervical 10/49 (20%) and sacral spine 7/49(14%). 19/49 (38%) had paravertebral abscesses, 5/49 (10%) had psoas abscesses. All patients had a repeat MRI spine at around 6 months (range 3 to 8 months) and 12 months (range 10 to 14 months). Twenty-eight out of 49 (56%) patients had persistent paravertebral and psoas abscesses at 6 months. All patients received 12 months of TB treatment and the majority of patients, 46/49 (92%) had complete resolution of paravertebral or psoas abscesses after 12 months of treatment. Conclusion Patients with spinal TB should have 12 months of treatment compared to 6 months as recommended by NICE guidelines. (Figure Presented).