{"id":"0c4d53e3-018f-473a-863e-fc4448cb0341","slug":"multidrug-resistant-tuberculosis-of-spine-diagnosis-and-management-an-institutional-experience-of-21-cases","title":"Multidrug-resistant tuberculosis of spine diagnosis and management: An institutional experience of 21 cases","authors":["Sunil Bhosale","Dipen Mukesh Ariwala","Akshay Phupate","Nandan Marathe","Harini Seshadri","Umang Sheth"],"abstract":"Background: We aimed to establish a standardized protocol for managing multidrug-resistant (MDR) spinal tuberculosis (TB), addressing the surgical options, ranging from computed tomography-guided biopsy to intraoperative sampling. Methods: This study developed a treatment/management protocol based on an analysis of clinical, radiological, and postoperative outcomes for 21 patients with spinal MDR-TB. Over 24 months, 21 patients with multidrug-resistant spinal TB underwent the following testing: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), numerical rating scale (NRS), and the American Spinal Injury Association Scale. Radiological criteria were based upon a comparison of preoperative and 6-month to 2-year postoperative plain radiographs. Results: The 21 patients underwent guided biopsies (35%) or intraoperative sampling (65%). For the surgical cases, dorsal vertebrae were most frequently involved (75%), and 90% underwent posterior surgical procedures. Postoperatively, ESR, CRP, kyphosis angle, and NRS score were significantly reduced. The 3 MDR patients who failed treatment were transitioned to the extensively drug-resistant (XDR) protocol wherein bedaquiline, linezolid, cycloserine, and clofazimine were given after drug sensitivity testing drug regimen, needed no further surgery, and none exhibited additional neurological deterioration. Conclusion: Regular clinical, laboratory, radiological, and outcome analysis is vital for following MDR spinal TB patients; early detection of relatively rare treatment failures (i.e., 3/21 patients in this series) allows for prompt initiation of XDR treatment, resulting in better outcomes.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/0c4d53e3-018f-473a-863e-fc4448cb0341/featured/hero-cropped-1781559197345.jpg","publishDate":"2024-09-27T00:00:00.000Z","doi":"10.25259/SNI_398_2024","categories":["Spine","Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2024/09/13122/SNI-15-344.pdf"}