Determining the Optimal Duration of Drug Therapy in Spinal Tuberculosis: A Cohort Study

Abstract

Background: Spinal tuberculosis (Pott’s spine) is a severe extrapulmonary TB affecting the vertebrae, causing significant morbidity and disability. Determining the optimal duration of anti-tubercular therapy (ATT) is crucial for improving patient outcomes and preventing relapse and drug resistance. The study aims to determine the optimal duration of drug therapy for spinal tuberculosis and to evaluate the clinical, radiological, and neurological outcomes associated with different treatment durations.

Methods: A cohort study was conducted over six years. 526 patients with Pott’s spine were enrolled and categorized based on ATT duration (12, 15-18, and >18 months). Clinical, radiological, and laboratory data were collected and analyzed using SPSS Software 21.0. Neurological status was assessed using Tuli’s grading system, and radiological healing was evaluated through changes in Modified Konstam’s angle.

Results: The average ATT duration was 14.8 months. Significant improvements in neurological status were observed, with 65.8% of patients improving to Grade 0 by the last follow-up (p < 0.001). Radiological healing showed a mean reduction in Modified Konstam’s angle from 38.5° to 22.7° (p < 0.001). The mean ESR decreased significantly from 55.4 mm/hr to 15.3 mm/hr (p < 0.001). The highest healing rate (90.9%) was seen in patients treated for >18 months. Surgical interventions in 15 patients led to substantial neurological, radiological, and pain relief improvements. A 6.6% relapse rate was observed during follow-up.

Conclusion: Prolonged ATT (15-18 months or more) is essential for achieving optimal healing in spinal tuberculosis. Clinical, neurological, and radiological outcomes significantly improve with extended treatment durations. Surgical interventions are effective for patients with severe symptoms. Regular follow-up is crucial to monitor and manage relapses.

Recommendations: Individualized treatment durations and comprehensive care protocols should be implemented to ensure the best outcomes for patients with spinal TB. Further research is recommended to refine treatment strategies and reduce relapse rates.

Keywords: Spinal Tuberculosis, Pott’s Spine, Anti-Tubercular Therapy, Neurological Outcomes, Radiological Healing, Surgical Intervention.