Spinal tuberculosis treatment duration: Correlating MRI findings with therapeutic outcomes

Tuberculosis (TB) of the spine is the most common form of musculoskeletal TB, especially in developing countries, and may lead to serious complications if untreated. Early diagnosis, anti-tubercular therapy (ATT), and surgery when needed are key to effective management. Magnetic resonance imaging (MRI) is the most reliable tool for diagnosis, monitoring, and determining treatment duration. This study aims to evaluate the appropriate length of ATT and MRI's role in guiding therapy in spinal TB.

This 36-month prospective study included 100 spinal TB patients treated with standard ATT. Clinical, hematological, and MRI evaluations guided therapy duration. Biopsy confirmed diagnosis, and surgery was done when indicated. MRI healing was classified as complete, partial, or non-healed. ATT continued until MRI confirmed healing. Multidrug-resistant cases received second-line therapy.

In a cohort of 100 spinal tuberculosis patients (mean age 23.5 years), 70% were female, and 88% had category-1 TB, with 12% exhibiting multidrug resistance. The thoracic spine was most affected (64%), followed by lumbar (30%) and cervical (6%) regions. Conservative treatment was administered to 78 patients, while 22 underwent surgery. Neurological deficits were present in 78% of cases. Diagnostic yields were highest with histopathology (50%), followed by GeneXpert (48%), smear microscopy (30%), and culture (28%). Inflammatory markers showed significant improvement: equivalent series resistance decreased from 34.95 to 13.1 mm/hr, and C-reactive protein from 32.4 to 6.3 mg/L over 12 months. MRI assessments revealed complete healing in 30% at 6 months and 80% at 12 months. By 18 months, recovery rates reached 89% clinically, 82% hematologically, and 88% radiologically.

Clinical recovery occurs first, but MRI is the most reliable tool for determining antitubercular therapy duration in spinal TB due to its accuracy in assessing disease resolution.