Results of management of spinal tuberculosis according to middle path regime and short course chemotheraphy


  • Jairam D. Jagiasi Department of Orthopaedics, B. Y. L. Nair Charitable Hospital and T. N. Medical College, Juhu, Mumbai
  • Mihir R. Patel Department of Orthopaedics, H. B. T. medical college and Dr R. N. Cooper hospital, Juhu, Mumbai



Tuberculosis, Spine, Anti tubercular therapy, Middle path regime


Background: Vertebral tuberculosis is the most common form of skeletal tuberculosis and it contributes about 50 percent of all cases of skeletal tuberculosis. The purpose of this study is to delineate the importance of middle path regime and short course chemotheraphy in the management of spine tuberculosis.

Methods: A prospective study was conducted which included 44 patients diagnosed as tuberculous spondylitis. Management was started as per middle path regime and drugs were given as per the revised national tuberculosis control program (RNTCP) regime category I under directly observed treatment, short-course (DOTS) therapy. Specimen was collected and studied for smear, culture, antibiotic sensitivity and histopathology. ATT was stopped at the end of 6 months as per DOTS schedule and MRI was done at the end of therapy.

Results: Dorsal spine lesions were found in 33 patients. 8 patients were smear positive and 38 patients were culture positive of whom 26 patients were sensitive to first line ATT drugs. 12 patients had MDR tuberculosis and were sensitive to 2nd line ATT drugs. 6 patients having negative culture were diagnosed from histopathology. All patients on 1st line ATT had satisfactory result. Only 8 patients with MDR tuberculosis recovered neurologically.

Conclusions: It is mandatory to do obtain tissue biopsy and examine culture, sensitivity and histopathology. Recently there is an increasing tendency in multidrug resistance cases and total drug resistant cases. By doing culture and sensitivity of the specimen we can find out the number of MDR cases and initiate proper drug regimen to avoid further complication and mortality.


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