Drug-resistant spinal tuberculosis - Current concepts, challenges, and controversies

Area of Science:

• Infectious Diseases
• Orthopedics
• Public Health

Background:

• The rise of drug-resistant tuberculosis strains, especially in developing nations, complicates global TB control efforts.
• Drug-resistant spinal tuberculosis presents significant management challenges due to poor treatment outcomes, sequelae, and a lack of established best practice guidelines.

Purpose of the Study:

• To systematically review the current epidemiology, clinical features, diagnostic updates, chemotherapy, surgical management, and outcomes of drug-resistant spinal tuberculosis.
• To identify gaps in current knowledge and emphasize the need for further research and large-scale trials in managing this complex condition.

Main Methods:

• A systematic computerized search was conducted across major databases including Cochrane, Scopus, Embase, Web of Science, and PubMed.
• Studies published over the last 30 years focusing on drug-resistance in spinal tuberculosis were analyzed.

Main Results:

• Limited data and lack of consensus exist regarding optimal drug regimens, duration, and therapeutic endpoints for drug-resistant spinal TB.
• While multi-drug chemotherapy remains primary, surgical intervention is crucial in specific clinical scenarios.

Conclusions:

• There is a critical need for updated evidence and standardized guidelines for the management of drug-resistant spinal tuberculosis.
• Further research and large-scale clinical trials are essential to improve treatment strategies and patient outcomes for drug-resistant spinal TB.