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Article: Clinical and radiological outcomes after conservative treatment of TB spondylitis: is the 15 years' follow-up in the MRC study long enough?

TitleClinical and radiological outcomes after conservative treatment of TB spondylitis: is the 15 years' follow-up in the MRC study long enough?
Authors
KeywordsConservative treatment
Outcomes
Spine
Tuberculosis
Issue Date2013
PublisherSpringer. The Journal's web site is located at http://www.springer.com/medicine/orthopedics/journal/586
Citation
European Spine Journal, 2013, v. 22 suppl. 4, p. S594-S602 How to Cite?
AbstractIntroduction: Tuberculosis of the spine is a still a common disease entity, not only in developing countries but is also returning in developed countries especially in the immune-compromised patients. Conservative treatment with chemotherapy is still the main stay of treatment. This article focuses on the clinical and radiological outcomes, and problems with conservative treatment. Method: The available literature of anti-tuberculosis chemotherapy in managing spinal tuberculosis was reviewed. Data sources included relevant literature of the English language identified through Medline search from 1946 to 2011. Personal experience and unpublished reviews from the authors' institution were also included. Results: Although majority of patients respond well to anti-tuberculosis chemotherapy, about 15 % of them develop paradoxical response. The Medical Research Council (MRC) studies have shown that for patients without significant neurological deficits, operative and conservative treatment could produce the same clinical outcome at 15 years follow-up. Patients treated operatively with debridement and spinal fusion with strut graft had faster bony fusion and less kyphotic deformity. In contrast, those treated with drugs alone or with simple debridement without fusion may result in disease reactivation, severe kyphosis or late instability, which in turn may lead to late-onset Pott's paraplegia, back pain, sagittal imbalance and compromised pulmonary function that are difficult or risky to treat. Conclusion: Recognition of the clinical and radiologic features of these late sequels is important for the management. Prevention of deformity in the early disease has been added to the modern standard of treatment of TB spine. © 2012 The Author(s).
Persistent Identifierhttp://hdl.handle.net/10722/147087
ISSN
2015 Impact Factor: 2.132
2015 SCImago Journal Rankings: 0.972
ISI Accession Number ID
References

Moon MS (1997) Tuberculosis of the spine; controversies and new challenges. Spine 22(15):1791–1797 doi: 10.1097/00007632-199708010-00022

Moon MS (2007) Tuberculosis of the spine—contemporary thoughts on current issues and perspective views. Curr Orthop 21:364–379 doi: 10.1016/j.cuor.2007.09.006

Jutte PC, Van Loenhout-Rooyackers JH (2006) Routine surgery in addition to chemotherapy for treating spinal tuberculosis. Cochrane Database Syst Rev, Issue 1, Art. No.: CD004532. doi: 10.1002/14651858.CD004532.pub2

Luk KD, Krishna M (1996) Spinal stenosis above a healed tuberculosis kyphosis. A case report. Spine 21(9):1098–1101 doi: 10.1097/00007632-199605010-00022

Jain AK, Aggarwal A, Mehrotra G (1999) Correlation of canal encroachment with neurological deficit in tuberculosis of spine. Int Orthop (SICOT) 23:85–86 doi: 10.1007/s002640050313

Marques CDL, Duarte ÂLBP, de Lorena VMB, Souza JR, Souza WV, de Miranda Gomes Y, de Carvalho EMF (2009) Evaluation of an interferon gamma assay in the diagnosis of latent tuberculosis infection in patients with rheumatoid arthritis. Rheumatol Int 30:57–62 doi: 10.1007/s00296-009-0910-y

Gupta RK, Agarwal P, Rastogi H, Kumar S, Phadke RV, Krishnani N (1996) Problems in distinguishing spinal tuberculosis from neoplasia on MRI. Neuroradiology 38:S97–S104 doi: 10.1007/BF02278131

Cheng VCC, Yam WC, Woo PCY, Lau SKP, Hung IFN, Wong SPY, Cheung WC, Yuen KY (2003) Risk factors for development of paradoxical response during antituberculosis therapy in HIV-negative patients. Eur J Clin Microbiol Infect Dis 22:597–602 doi: 10.1007/s10096-003-0998-z

Breen RA, Smith CJ, Bettinson H et al (2004) Paradoxical reactions during tuberculosis treatment in patients with and without HIV co-infection. Thorax 59:704–707 doi: 10.1136/thx.2003.019224

Medical Research Council Working Party on Tuberculosis of the Spine (1998) A 15-year assessment of controlled trials of the management of tuberculosis of the spine in Korea and Hong Kong. J Bone Joint Surg Br 80:456–462 doi: 10.1302/0301-620X.80B3.8544

Medical Research Council Working Party on Tuberculosis of the Spine (1974) A controlled trial of anterior spinal fusion and debridement in the surgical management of tuberculosis of the spine in patients on standard chemotherapy: a study in Hong Kong. Br J Surg 61:853–866 doi: 10.1002/bjs.1800611102

Luk KDK (1999) Tuberculosis of the spine in the new millennium. Eur Spine J 8:338–345 doi: 10.1007/s005860050185

Moon MS, Moon JL, Moon YW, Kim SS, Kim SS, Sun DH, Choi WT (2003) Pott’s paraplegia in patients with severely deformed dorsal or dorsolumbar spines: treatment and prognosis. Spinal Cord 41:164–171 doi: 10.1038/sj.sc.3101366

Rajasekaran S (2001) The natural history of post-tubercular kyphosis in children. Radiological signs which predict late increase in deformity. J Bone Joint Surg Br 83(7):954–962 doi: 10.1302/0301-620X.83B7.12170

Rajasekaran S, Vijay K, Shetty AP (2010) Single-stage closing-opening wedge osteotomy of spine to correct severe post-tubercular kyphotic deformities of the spine: a 3-year follow-up of 17 patients. Eur Spine J 19:583–592 doi: 10.1007/s00586-009-1234-z

 

DC FieldValueLanguage
dc.contributor.authorCheung, WYen_HK
dc.contributor.authorLuk, KDKen_HK
dc.date.accessioned2012-05-25T07:50:33Z-
dc.date.available2012-05-25T07:50:33Z-
dc.date.issued2013en_HK
dc.identifier.citationEuropean Spine Journal, 2013, v. 22 suppl. 4, p. S594-S602en_HK
dc.identifier.issn0940-6719en_HK
dc.identifier.urihttp://hdl.handle.net/10722/147087-
dc.description.abstractIntroduction: Tuberculosis of the spine is a still a common disease entity, not only in developing countries but is also returning in developed countries especially in the immune-compromised patients. Conservative treatment with chemotherapy is still the main stay of treatment. This article focuses on the clinical and radiological outcomes, and problems with conservative treatment. Method: The available literature of anti-tuberculosis chemotherapy in managing spinal tuberculosis was reviewed. Data sources included relevant literature of the English language identified through Medline search from 1946 to 2011. Personal experience and unpublished reviews from the authors' institution were also included. Results: Although majority of patients respond well to anti-tuberculosis chemotherapy, about 15 % of them develop paradoxical response. The Medical Research Council (MRC) studies have shown that for patients without significant neurological deficits, operative and conservative treatment could produce the same clinical outcome at 15 years follow-up. Patients treated operatively with debridement and spinal fusion with strut graft had faster bony fusion and less kyphotic deformity. In contrast, those treated with drugs alone or with simple debridement without fusion may result in disease reactivation, severe kyphosis or late instability, which in turn may lead to late-onset Pott's paraplegia, back pain, sagittal imbalance and compromised pulmonary function that are difficult or risky to treat. Conclusion: Recognition of the clinical and radiologic features of these late sequels is important for the management. Prevention of deformity in the early disease has been added to the modern standard of treatment of TB spine. © 2012 The Author(s).en_HK
dc.languageengen_US
dc.publisherSpringer. The Journal's web site is located at http://www.springer.com/medicine/orthopedics/journal/586en_HK
dc.relation.ispartofEuropean Spine Journalen_HK
dc.rightsThe Author(s)en_US
dc.rightsCreative Commons: Attribution 3.0 Hong Kong Licenseen_US
dc.subjectConservative treatmenten_HK
dc.subjectOutcomesen_HK
dc.subjectSpineen_HK
dc.subjectTuberculosisen_HK
dc.titleClinical and radiological outcomes after conservative treatment of TB spondylitis: is the 15 years' follow-up in the MRC study long enough?en_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://www.springerlink.com/link-out/?id=2104&code=C317NP1606251710&MUD=MPen_US
dc.identifier.emailLuk, KDK:hcm21000@hku.hken_HK
dc.identifier.authorityLuk, KDK=rp00333en_HK
dc.description.naturepublished_or_final_versionen_US
dc.identifier.doi10.1007/s00586-012-2332-xen_HK
dc.identifier.pmid22565800-
dc.identifier.scopuseid_2-s2.0-84892821170en_HK
dc.identifier.hkuros223394-
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dc.relation.referencesdoi: 10.1002/14651858.CD004532.pub2en_US
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dc.identifier.volume22-
dc.identifier.issuesuppl. 4-
dc.identifier.spageS594en_HK
dc.identifier.epageS602en_HK
dc.identifier.eissn1432-0932en_US
dc.identifier.isiWOS:000320884200009-
dc.publisher.placeGermanyen_HK
dc.description.otherSpringer Open Choice, 25 May 2012en_US
dc.identifier.scopusauthoridCheung, WY=55188419600en_HK
dc.identifier.scopusauthoridLuk, KDK=7201921573en_HK
dc.identifier.citeulike10672048-

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