Case Report: Clinical Improvement with Non-Surgical Management of Tuberculous Spondylitis

Background: Tuberculosis is the second most common fatal infectious disease after Acquired Immunodeficiency Syndrome (AIDS) in the world. The spine is involved in 50% of osteoarticular tuberculosis cases. Tuberculous Spondylitis (TS) is the most dangerous form of osteoarticular tuberculosis, because of its ability to destroy the vertebral body with subsequent permanent kyphosis and neurological deficits such as paraplegia. The treatment goals of TS are to eradicate the infection and provide stability for the affected spine. There is little information in the literature about systemic non-surgical treatment under the condition of spinal cord compression in TS. We report two cases of TS which was improved with non-surgical treatment. We believe that the clinico-radiological signs of spinal cord compression in these cases are not an emergency indication for surgery. Clinical Presentation and Intervention: Two women aged 34 and 26 years were hospitalized because of the upper motor neuron type weakness in both legs worsened gradually, descending numbness, without urinary or defecation problems. Magnetic resonance imaging depicted lesions on vertebral bodies supporting the diagnosis of TS. Both patients were received oral antituberculous therapy and their muscle force improved despite the kyphotic deformity in the first patient. Conclusion: Neuro-radiological evidence of spinal cord compression is not an emergency indication of surgery in the management of TS and clinical improvement can be obtained by nonsurgical treatment.