Paradoxical response in spinal tuberculosis: Lessons learnt

Area of Science:

• Orthopedics
• Infectious Diseases
• Radiology

Background:

• Spinal tuberculosis (TB) management can be challenging when lesions increase despite antituberculous treatment (ATT).
• Empirical ATT is common, but paradoxical responses require careful monitoring and intervention.

Purpose of the Study:

• To describe the experience in managing spinal tuberculosis cases with paradoxical lesion enlargement.
• To evaluate conservative versus surgical management strategies for these challenging cases.

Main Methods:

• Retrospective analysis of 80 spinal TB patients treated between January 2012 and June 2014.
• Comparison of surgical intervention (50 patients) versus conservative management (30 patients) with ATT.
• Detailed review of six patients exhibiting paradoxical lesion increase on ATT, with subsequent interventions.

Main Results:

• Conservative management, including ultrasound-guided abscess tapping and continued ATT, was effective in three patients with paradoxical responses.
• Surgical intervention was performed in three other patients with paradoxical responses.
• Patients showed symptomatic improvement, including weight gain and appetite normalization, with resolution of lymphopenia.

Conclusions:

• Conservative management, including abscess drainage/aspiration and continued ATT, is the primary approach for paradoxical responses in spinal TB.
• Surgical decompression and stabilization are reserved for cases with new neurological deficits, deformity, or instability.