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TUBERCULOSIS OF THE LUMBAR SPINE



Abstract

40% Of the cases of tuberculous (TB) spondylitis involve the lumbar spine. Despite the large forces borne by the lumbar spine and subsequent disability that may result from the TB infection, no studies have reported on the functional outcome. We review the clinical, radiological and patient-orientated functional outcomes using the Oswestry Disability index (ODI) following treatment of lumbar spine TB.

The final radiological and ODI assessment was undertaken at follow-up during October 2005 and March 2006 in 37 patients, treated non-operatively for TB of the lumbar spine. The diagnosis was established following a closed needle biopsy.

The mean age at follow-up was 35 (range 16 to 76 years). The average duration of symptoms prior to presentation was 9 months (range 2 to 24 months). All patients presented with low backache and night pain but only 42% had constitutional symptoms. 92% had 2-body involvement and L3/4 segment was most commonly involved (35%). The kyphosis measured 130 (range 400 kyphosis to 130 lordosis) and the mean overall lumbar curve was +10 (range 260 kyphosis to 360 lordosis). Ten patients had coronal plane deformity averaging 100 (00 to 220). All patients had a minimum of 6 months of anti-TB treatment (6 to 24 months), 76% used spinal brace for a mean of 5 months (2 to 24 months). At the last follow-up the kyphosis was 170 (380 kyphosis to 80 lordosis) with overall average lumbar curve of +30 (180 kyphosis to 360 lordosis). 11 Had mean coronal deformity of 90 (00 to 140). 34 Of the patients showed full radiological fusion. The mean ODI was 19% (0 to 55%).

We conclude that a favourable functional outcome can be expected with conservative treatment of lumbar spine TB, despite the deformity.

Correspondence should be addressed to: Léana Fourie, CEO SAOA, PO Box 12918, Brandhof 9324 South Africa.