To the Editor
We have read the article “Management of Spine Tuberculosis With Chemotherapy and Percutaneous Pedicle Screws in Adjacent Vertebrae” by Yang et al1 published in Spine journal Volume 41, Number 23, with great interest and at the outset congratulate the authors for their informative work. In the present study the authors have tried to emphasize on two important points in the management of tubercular spine lesion: first is the efficacy of the minimal invasive stabilization of tubercular spine and second is the combined local and systemic anti tuberculosis drug administration after minimal invasive decompression of the spinal cord caused by abscess. However, we would like to bring forth our queries about this study for a more detailed clarification.
As a reader, we interpreted that the authors wish to propose the minimal invasive stabilization of the spinal tuberculosis in cases without any severe deformity of the diseased spine. But addition of quantitative value of deformity and any effect of involved spinal column on the decision making would complement to information and may avoid the nonjudicious use of the proposed treatment strategy.
Selective approach to decompress the spinal cord because of abscess will be further helpful in minimizing the surgical insult and deal the condition in more biological manner and limited morbidity.2 But we are eager to know from the author that is the spinal cord compression caused by abscess is the ideal case for the said technique or the same can be extended to the situation in which the compression is caused by granulation tissue, posterior spinal tuberculosis, which often demands more exploratory approach, were these cases excluded, or is it possible to deal with the same strategy and if so what are the treatment protocols to be followed.
Local use of the anti tuberculosis drug, especially streptomycin3 is well documented but here authors have extended method and drugs for the local antitubercular therapy with use of the inlet and outlet suction irrigation tube.3,4 The application of suction irrigation with antibiotic solution was in practice for the septic osteomyelitis but application of the same for the anti tuberculosis drugs is new information given in the present study. But with a short-term study and less number of cases it may not be possible to generalize its safety and efficacy in term of toxicity, resistance, and possibility of secondary infection because of local draining tube for long period. A better-designed study would be helpful to look at all these parameters and at the same time need for any modification in the dosage and duration of antitubercular therapy.