Caries Spine: A Comparative Study between Medical Management Alone with Combined Medical and Surgical Management

  • Syed Saleem Shah Jinnah Postgraduate Medical Centre, Karachi.
  • Farrukh Javeed Jinnah Postgraduate Medical Centre Karachi.
  • Lal Rehman Jinnah Postgraduate Medical Centre, Karachi.
  • Ali Afzal, FCPS Jinnah Postgraduate Medical Centre, Karachi.
  • Munwar Ali Jinnah Postgraduate Medical Centre, Karachi.
  • Shakeel Ahmed Jinnah Postgraduate Medical Centre, Karachi.
Keywords: Caries spine, Anti tuberculous therapy, , Surgical treatment


Objective:  To compare short term outcome of combined surgical and medical management versus medical management alone in caries spine.
Material and Methods:  This study was conducted from August 2015 to August 2018, on 68 patients randomly divided into two groups of 34 each. All were diagnosed cases of Caries spine based on history, clinical examination, ESR and imaging appearances. Group A underwent surgical intervention along with Anti-Tuberculous Treatment (ATT) while Group B received medical treatment (ATT) alone. 

Results:  There were 37 (54.41%) males and 31 (45.59%) females with mean age of 34.84 ± 10.6 years. The thoracic spine was the commonest site in 33 (48.5%) patients, followed by lumbar in 20 (20.8%), dorso-lumbar in seven (10.3%) and cervical in four (5.88%) patients. The ESR fell from 85mm/hr to 24.46mm/hr in Group A and to 41.92mm/hr in Group B (p = 0.0124). Overall improvement in Frankel grade was seen in 25 (73.5%) patients in Group A and 12 (35.3%) in group B. In group A, improvement seen from grade A in two (8%), grade B in three (12%), grade C in 12(48%), Grade D in seven (28%) patients, (p = 0.000) while eight (23.5%) patients remained same and only one (2.5%) deteriorated from baseline neurological status. In Group B, 16 (47%) patients remained same and six (17.6%) deteriorated. 
Conclusion:  Surgery combined with antituberculous therapy was found to be beneficial in patients suffering from caries spine and to be recommended to patients desiring rapid recovery


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Original Article