The final results up to 15 years are reported of clinical trials of the management of
tuberculosis of the spine in Korea and Hong Kong. In Korea, 350 patients with active
spinal tuberculosis were randomised to ambulatory
chemotherapy or
bed rest in hospital (in
Masan) or a
plaster-of-Paris jacket for nine months (in Pusan). Patients in both centres were also randomised to either PAS plus
isoniazid for 18 months or to the same drugs plus
streptomycin for the first three months. In Hong Kong, all 150 patients were treated with the three-
drug regime and randomised to either radical excision of the spinal lesion with bone graft or open
debridement. On average, the disease was more extensive in Korea, but at 15 years (or 13 or 14 years in a proportion of the patients in Korea) the great majority of patients in both countries achieved a favourable status, no evidence of CNS involvement, no radiological evidence of disease, no sinus or clinically evident
abscess, and no restriction of normal physical activity. Most patients had already achieved a favourable status much earlier. The earlier results of these trials are confirmed by the long-term follow-up with no late relapse or late-onset
paraplegia. The results of
chemotherapy on an outpatient basis were not improved by
bed rest or a plaster jacket and the only advantage of the radical operation was less late
deformity compared with
debridement. A second series of studies has shown that short-course regimes based on
isoniazid and
rifampicin are as effective as the 18-month regimes: ambulatory
chemotherapy with these regimes should now be the main management of uncomplicated
spinal tuberculosis.