Conservative management of tuberculous spondylitis in a developing country

Tuberculous spondylitis is a significant health burden in the Third world. Tuberculosis and its complications are on the increase because of the HIV/AIDS challenge. The aim of this study was to review the patients managed for tuberculous spondylitis at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.

This was a retrospective study of patients seen at the University of Port Harcourt Teaching Hospital between January 1999 and December 2002 with tuberculosis of the spine. Patients case notes were reviewed after collating out-and-in-patient records. Analysis was done using multiway frequency tables.

There were 16 males and 18 females, with a ratio of 1:1.1. Their ages ranged from 3.3 to 82 years with an average of 31.1. Peak ages of occurrence were the 3rd and 4th decades. Eighteen patients (52.9%) presented within the first 6 months of symptoms. The most frequent presenting symptoms were back pain, weight loss, difficulty with walking, low grade fever, and night sweats. The most frequent signs were gibbus and lower limb paralysis. The most common association was pulmonary tuberculous (32.4%). The thoracic spine was mostly affected, followed by the lumbar spine. Wedge collapse of the vertebrae was the common radiological finding. Twenty two patients had multilevel affection. Twenty patients (71%) had a lymphocyte differential of more than 45%, 87% had erythrocyte sedimentation rate of over 20 mm/hr. Westergren, and Mantoux test was positive in 55 percent of the patients. Twelve patients had outpatient treatment and 22 had in-patient treatment. Duration of hospital stay ranged from 7 to 157 days with an average of 62.6 days. All the patients had standard combination antituberculosis therapy. No patient had surgery for tuberculous spondylitis. Outcome of treatment was good (68.2%). Follow up was poor with a high default rate. There were 3 mortalities (8.8%).

Diagnostic delays partly due to lack of experience makes a high index of suspicion necessary to make a diagnosis. Outcome utilizing conservative methods of treatment is good.