ISPUB.COM The Internet Journal of Orthopedic Surgery Volume 2 Number 2 1 of 10 Tuberculosis Of The Lumbar Spine: Outcomes After Combined Treatment With Short-Course Two-Drug Therapy And Surgery O Karaeminogullari, U Aydinli, R Ozerdemoglu, C Ozturk Citation O Karaeminogullari, U Aydinli, R Ozerdemoglu, C Ozturk. Tuberculosis Of The Lumbar Spine: Outcomes After Combined Treatment With Short-Course Two-Drug Therapy And Surgery. The Internet Journal of Orthopedic Surgery. 2004 Volume 2 Number 2. Abstract The purpose was to evaluate complications and treatment results in patients with tuberculosis of the lumbar spine. Eighteen patients with active tuberculosis of the lumbar spine were treated surgically in the Department of Orthopedic Surgery at Uludag University School of Medicine between the years 1993 and 2000. All the patients received a short course of anti-tuberculosis combination drug therapy (isoniazid and rifampicin) for 9 months. The patients who underwent anterior radical debridement + anterior fusion and/or posterolateral debridement + posterior fusion + stabilization showed 5-8 degrees correction of local angulation after surgery; however, the number of patients was too small for statistical analysis. The mean loss of correction at final follow-up of meanly 5 years in cases of anterior or posterior surgery alone was 45-50%, whereas the corresponding finding for the combined approach was 12%. The combination of short-term two-drug chemotherapy (daily isoniazid plus rifampicin for 9 months) and surgery is effective for tuberculosis of the lumbar spine. INTRODUCTION Tuberculosis (TB) is the most common granulomatous bacterial infection of the spine. The goals of management are to eradicate the infection and prevent or treat neurological deficits and/or spinal deformities. Short-course (6- or 9- month) regimens of chemotherapy with daily isoniazid and rifampicin are highly effective for treating TB cases with positive bronchoalveolar smears [ 4 ]. The same regimen is expected to be effective in spinal TB based on its paucibacillary nature. The literature reports different treatment outcomes for spinal TB relative to duration of anti-tuberculosis treatment (6-18 months), the number of drugs used (two to four per regimen), and frequency of drug administration (daily, or twice or three times weekly). In a meta-analysis from Turkey [ 24 ], the duration of drug usage ranged from 6-18 months and four-drug chemotherapy was used by most centers. Parthasarathy et al. [ 17 ] found that two-drug chemotherapy (daily isoniazid + rifampicin) for 9 months yielded the most favorable results. Resistance to first-line drugs is not a major problem in osteoarticular TB due to the small load of microorganisms present and the absence of closed caseous lesions. Also, two-drug chemotherapy is advantageous with respect to lower toxicity. Isoniazid + rifampicin is the most effective drug combination from a bacteriological perspective. In recent years, numerous studies [ 10 , 20 ] have advocated radical anterior surgery (debridement and grafting) for correction and prevention of kyphosis in cases of spinal TB. The reason is that debridement alone may result in development of a kyphotic deformity, particularly in cases with multi-segmental involvement [ 20 ]. However, even this radical surgery is not always sufficient for preventing progressive kyphosis, because lack of stability is common in these cases, as is graft failure due to fracture, absorption, or slippage [ 20 ]. External support or prolonged bed rest with surgery and drugs do not seem to be adequate for treating spinal TB. These approaches are not comfortable, and are sometimes intolerable for patients. Use of internal fixation devices in the surgery seems to be the best choice for stabilizing the spine, for early return to daily life activities and normal comfort levels, and for maintaining the degree of correction. In this report, we present the clinical results for cases of lumbar TB at our center that were treated with the combination of surgery and a 9-month course of daily