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Analysis Of Changing paradigms of management in 179 Patients Over 12 Year Period & Proposal Of A New Management Algorithm.
MedLine Citation:
PMID:  23348057     Owner:  NLM     Status:  Publisher    
OBJECTIVE: To describe management and outcome in a large cohort of patients with spinal tuberculosis METHODS: 212 patients of spinal tuberculosis treated between Jan 1999-June 2011 of which, 179 patients were included (> 6 months follow-up, mean age- 34.8 years; age range 10-75 years). The cohort was divided into 2 groups (n = 89 and 90 respectively), Group I :1999-2003 and Group II: 2004-2011. RESULTS: There were 93 males. Mean age was 34.8 + 7.2 years (range: 10-75 years). Mean duration of symptoms was 2.4 months. Sensory-motor deficits were present in 167 (93.5%; 74 patients were paraplegic), 156 (87%) had pain, 127 (71.7%) had bladder involvement and extra spinal tuberculosis was present in 36 patients (22.3%). 92% were on prior chemotherapy, 1/5(th) of the total on second-line chemotherapy. Thoracic spine was commonest (n= 86, 57%), followed by cervical (n=50, 29%), craniovertebral junction (22, 15%) and lumbo-sacral spine (n= 20, 10.5%). 146 patients underwent surgery, 68% instrumented fusions and 16% circumferential fusions. Mean follow-up: 20.2 months (range 6-60 months). 89% improved in motor/sensory deficits, 71% improved in pain, 88% improved in bladder symptoms, paraplegia improved in 77%. Group II had higher incidence of cord compression (p<0.01), severe vertebral body (p<0.001) collapse and paraplegia (p<0.001). Group II underwent more instrumented surgeries (p<0.01), especially circumferential fusions (p<0.001). The improvement of paraplegia was better after 2004 (Group II). Bladder symptoms correlated with the timing of surgery (p<0.1) CONCLUSION: Medical treatment is the main stay, however radical, instrumented surgeries should be offered when indicated. Presence of paraplegia should not preclude surgery. A practical management paradigm is also suggested.
Sarat P Chandra; Ajit Singh; Nishant Goyal; Rajender K Laythalling; Manmohan Singh; Sharad S Kale; Manish S Sharma; Ashish Suri; Pankaj Singh; Ajay Garg; Chitra Sarkar; Bhawani S Sharma; Ashok K Mahapatra
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-21
Journal Detail:
Title:  World neurosurgery     Volume:  -     ISSN:  1878-8750     ISO Abbreviation:  World Neurosurg     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101528275     Medline TA:  World Neurosurg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
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