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The five-year assessment of three randomised trials of short course (6, 9 or 18 months) chemotherapy for tuberculosis of the spine is reported. In Hong Kong patients were randomised to isoniazid plus rifampicin (HR) daily for 6 or 9 months, combined with radical surgical resection with bone grafting and streptomycin for 6 months for all patients. In Madras patients were randomised to chemotherapy with HR for 6 or 9 months, or 6 months HR chemotherapy combined with surgical resection. In Korea all patients were ambulatory and were randomised to different regimens of chemotherapy 6 or 9 months HR, or 9 or 18 months isoniazid plus ethambutol. (EH) or isoniazid plus PAS (PH). In all centres the results of the 6- and 9-month regimens of HR were excellent and similar to the 18-month EH and PH regimens. The 9-month EH/PH regimens were clearly inferior. In Hong Kong excellent results were achieved by the radical resection. The disease was however less extensive than in Madras, where the results after surgery were no better than with ambulatory chemotherapy. Chemotherapy is the critical factor in the management of tuberculosis of the spine. Efforts should be concentrated on ensuring that appropriate regimens are given under adequate supervision.

Type

Journal article

Journal

Int Orthop

Publication Date

1999

Volume

23

Pages

73 - 81

Keywords

Adolescent, Adult, Ambulatory Care, Aminosalicylic Acid, Antitubercular Agents, Bone Transplantation, Child, Child, Preschool, Combined Modality Therapy, Drug Therapy, Combination, Ethambutol, Female, Humans, Infant, Isoniazid, Male, Middle Aged, Osteotomy, Radiography, Rifampin, Streptomycin, Time Factors, Treatment Outcome, Tuberculosis, Spinal