Is surgery always the most appropriate option for a patient with tuberculosis of the spine?

Systematic review

Jutte PC, Van Loenhout-Rooyackers JH. Routine surgery in addition to chemotherapy for treating spinal tuberculosis. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD004532.

To compare chemotherapy plus surgery with chemotherapy alone for treating people diagnosed with active tuberculosis of the spine.

Well-defined question/objective
Thorough, reproducible search of the literature
Selection criteria: RCT with at least 1 year follow up comparing chemotheray to chemotherapy plus surgery to treat active tuberculosis of the spine
2 authors indepentently assessed studies for inclusion

Two RCTs met criteria with a total of 331 participants; one trial look at surgical debridement with no reconstruction, the other trial studied debridement and reconstruction with bone graft.  Trials reported on kyphosis angle, neurological deficit, bony fusion, absence of spinal tuberculosis, all-cause mortality, and regained activity level.  See Comparison for summary (click on particular outcome or subgroup title to see forest plot summarizing results.

Authors caution that due to small size of these trials, no conclusion can be made about routine surgery (rather than surger when clinical indicated) for active tuberculosis of the spine.

About Amy

Clinical Informationist at EUH Branch Library
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