- Equivalent Long-term Transplantation Outcomes for Kidneys Donated After Brain Death and Cardiac Death: Conclusions From a Nationwide Evaluation
- Low-dose triple drug combination targeting the PI3K/AKT/mTOR pathway and the MAPK pathway is an effective approach in ovarian clear cell carcinoma
- Altered cochlear innervation in developing and mature naked and Damaraland mole rats
- Target population's requirements on a community-based intervention for stimulating physical activity in hard-to-reach physically disabled people: an interview study
- 'He usually has what we call normal fevers': Cultural perspectives on healthy child growth in rural Southeastern Tanzania: An ethnographic enquiry
- Genome-wide association meta-analyses and fine-mapping elucidate pathways influencing albuminuria
- Distress, problems, referral wish, and supportive health care use in breast cancer survivors beyond the first year after chemotherapy completion
- Trends in governmental expenditure on vaccination programmes in the Netherlands, a historical analysis
- Sacrospinous hysteropexy versus vaginal hysterectomy with uterosacral ligament suspension in women with uterine prolapse stage 2 or higher: observational follow-up of a multicentre randomised trial
- Blood eosinophil count and airway epithelial transcriptome relationships in COPD versus asthma
Most Used Journals
Author Archives: Jutte PC, van Loenhout-Rooyackers JH
Routine surgery in addition to chemotherapy for treating spinal tuberculosis.
Cochrane Database Syst Rev. 2013;5:CD004532
Authors: Jutte PC, van Loenhout-Rooyackers JH
BACKGROUND: Tuberculosis is generally curable with chemotherapy, but there is controversy in the literature about the need for surgical intervention in the one to two per cent of people with tuberculosis of the spine.
OBJECTIVES: To compare chemotherapy plus surgery with chemotherapy alone for treating people diagnosed with active tuberculosis of the spine.
SEARCH METHODS: We searched the Cochrane Infectious Diseases Group Specialized Register (February 2010), CENTRAL (The Cochrane Library 2010,Issue 1), MEDLINE (1966 to February 2010), EMBASE (1974 to February 2010), LILACS (1982 to February 2010), conference proceedings, and reference lists. A search update in November 2012 revealed no new studies.
SELECTION CRITERIA: Randomized controlled trials with at least one year follow up that compared chemotherapy plus surgery with chemotherapy alone for treating active tuberculosis of the thoracic and/or lumbar spine.
DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial eligibility, methodological quality, and extracted data.We analysed data using odds ratio with 95% confidence intervals.
MAIN RESULTS: Two randomized controlled trials (331 participants) met the inclusion criteria. They were conducted in the 1970s and 1980s with follow-up reports available after 18 months, three years, and five years; one trial also reported 10 years follow up. Completeness of follow up varied at the different time points, with less than 80% of participants available for analysis at several time points. There was no statistically significant difference for any of the outcome measures: kyphosis angle, neurological deficit (none went on to develop this), bony fusion, absence of spinal tuberculosis, death from any cause, activity level regained, change of allocated treatment, or bone loss. Neither trial reported on pain. Of the 130 participants allocated to chemotherapy only, 12 had a neurological deficit and five needed a decompression operation. One trial suggested that an initial kyphosis angle greater than 30° is likely to deteriorate, especially in children.
AUTHORS’ CONCLUSIONS: The two included trials had too few participants to be able to say whether routine surgery might help. Although current medication and operative techniques are now far more advanced, these results indicate that routine surgery cannot be recommended unless within the context of a large, well-conducted randomized controlled trial. Clinicians may judge that surgery may be clinically indicated in some groups of patients. Future studies need to address these topics as well as the patient’s view of their disease and treatment.
PMID: 23866317 [PubMed – indexed for MEDLINE]