Tuberculosis of the spine : Presentation, Management and short-term outcome of treatment at the University Teaching Hospital, Lusaka, Zambia

Abstract

In this study, 32 patients with tuberculosis of the spine who presented to the University Teaching Hospital (UTH) in Lusaka, Zambia and who satisfied specific inclusion criteria for the study were followed up for a period of six months. The group comprised 18 male (56%) and 14 female (44%) patients with an average age of 30.2 years (range was from 2 to 83 years). The main symptoms at presentation were back pain (81 %), deformity of the spine (69%) and weakness of the legs (66%). One patient (3%) had a cervical lesion, 22 patients (67%) had thoracic lesions and 10 patients (30%) had lumbar lesions. Categorization by site of involvement showed affection of the thoracic and lumbar spine to be 54% and 46% respectively in the HIV-positive patients and 5% (1 out of 20) for the cervical spine, 75% (15 out of 20) for the thoracic spine and 20%) (4 out of 20) for the lumbar spine in the HIV-negative patients. 17 patients (53%) presented with marked neurological deficit (Frankel grades A B & C) while 15 patients (47%.) presented with almost normal neurological status (D & E). After a minimum of 2 months on conservative management most patients showed improvement resulting in 10 patients (31%.) with marked neurological deficit and 22 (69%.) with almost normal neurology. However 3 patients (9%) deteriorated from Frankel grade B to A while four (13%) remained static with one patient at grade A and three patients at grade B. Five patients (16%) had to undergo surgical treatment for TB spine. Histology confirmed TB in 4 patients while one was non-specific. There were two mortalities one each from the conservatively managed and the surgically managed groups. Surgery improved the mean kyphosis angle from 40° (range 27°-52°) to 22.5° (range 15°-30°). There was no difference in response to treatment between the HIV-negative and the HIV-positive patients.