Abstract
This is an evaluation of outcomes in 12 patients with tuberculosis of the lower lumbar spine (L3 and below) treated by the author between 1998 and 2003.
Clinical presentation, demographics, comorbidity, treatment and response to treatment over 12 months were assessed. All patients presented with backache. Two had abscesses, one in the groin and one at the Petit triangle. Three patients had Frankel-D neurological fallout. In most, L3/4 was involved. Two patients had L5/ S1 involvement, with associated spondylolisthesis. Two were HIV-positive and one was diabetic.
All patients were treated with antituberculous medication and initial bed rest until they were free of pain. The only surgical treatment was needle biopsy and abscess drainage. The acute back pain with which patients presented was better by the 4th week. The neurological symptoms resolved in all three patients. At final follow-up, there was good bony fusion although all had loss of lumbar lordosis. None of the patients who were working became unemployed.
In keeping with results in the literature, good outcomes were achieved with conservative treatment. With the advent of good pedicle instrumentation and vertebral body cages, there is a temptation to manage these patients with radical surgery. However, there is no justification for such an approach, especially if one considers that so far no relationship between kyphosis and backache has been shown.
The limitation of this study is the small number of patients.
Secretary: Dr H.J.S. Colyn, Editor: Professor M.B.E. Sweet. Correspondence should be addressed to SAOA, Box 47363, Parklands, Johannesburg, 2121, South Africa.
