Standard guideline needed in treating spinal TB

Conference: Lack of standard guidelines to treat bone or spinal tuberculosis (TB) has left doctors at the orthopedic department of the Jigme Dorji Wangchuck national referral hospital (JDWNRH) unclear.

Spinal TB, medically known as Pott’s spine, occurs at the lumbar (lower part of the spine) in children and adults, and for the elderly it is seen in the knee and pelvic area.

The orthopedic department has been treating minor and severe cases of spinal TB, including other bone TB. But treatments vary from conservative to surgical management.

At the second day of the fourth annual medical conference, yesterday, spinal surgeon Dr Kuenzang Wangdi, during a paper presentation said hospitals in Bhutan are in immediate need of proper guidelines for treating spinal TB. He said the number of spinal TB is on the rise.

“Some health workers treat for six months and some for 12 months but its treated for 12-18 months in India and Thailand. There is no standards in the duration of spinal TB treatment in Bhutan,” he said.

He added that the literature review recommends more than six months treatment.

In 2014 a total of 10 bone TB cases were admitted of which five cases were spinal TB. It was diagnosed in the out-patient department. Spinal tuberculosis is indolent and grows slowly, which can be diagnosed both clinically and radiologically in endemic regions. MRI is better at detecting the lesions compared to radiography.

Bone TB or spinal TB is reflected as extra-pulmonary TB in the tuberculosis program, so the treatment regimen is similar to pulmonary TB.

Dr Kuenzang explained that 90 percent of tuberculosis occurs in lungs (pulmonary) and the remaining 15-20 percent are presented as extra pulmonary.

“Our TB program should review the treatment regimen. The present duration of treatment is too short. It might lead to many complications like neurological deficit and deformity,” he said.

He recommended 12-18 months treatment depending upon the clinical presentations and severity of the disease.

Dr Tshewang Thinley, who recently retired from the orthopedic department, said during his tenure, he treated patients with spinal TB for 18-24 months.

“My treatment depended on treatment response and laboratory recommendation,” he said. “There are no clear cut guidelines anywhere.”

Medical specialist, Dr D B Subba said that the situation is “shocking”. He said different doctors treat for different duration.

“We need some protocols. Spinal TB should be treated for 12 months,” he said adding that there cannot be follow-ups for the illness.

The former medical specialist of JDWNRH, Dr Ballab Sharma, who is currently with Punatsangchhu hydropower project, said there is an Indian woman in Bajothang hospital who has been treated for spinal TB for last three years.

“Treatment duration of spinal TB is debatable,” he said.

By Nirmala Pokhrel

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