Chemotherapy of Tuberculosis of the Spine

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1. Sixty-four adults with tuberculosis of the spine were treated principally with prolonged courses of antituberculosis drugs, bed rest, and braces. Surgical procedures for abscess evacuation and for the treatment of paraplegia were carried out in some cases, but spine fusion was not performed. These patients have been followed for from two to fourteen years.

2. The response to treatment of the vertebral lesions, abscesses, and sinuses was, on the whole, favorable.

3. Eight patients had spinal-cord involvement with paralysis; four recovered completely, and the others showed various degrees of recovery. Costotransversectomy and laminectomy were the operative procedures performed in these cases.

4. Two patients failed to respond to treatment and died of tuberculosis; twelve had relapses and two of these died; the remainder responded to retreatment. The relapses occurred in patients treated with streptomycin in the early years of antituberculosis drug therapy. Isoniazid appears to be more effective than streptomycin in preventing relapse.

5. While there are limited indications for surgical spine fusion in tuberculosis, it is not a substitute for adequate antituberculosis drug therapy.

6. The recommended drug program for most adults is 300 milligrams of isoniazid and twelve grams of para-aminosalicylic acid daily for two and one-half years.

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