Sriram, K and Somasundaram, P R and Parthasarathy, R and Chandrasekaran, V
(2006)
A reliable and simple method for identifying at start
patients with tuberculosis of the spine suitable for
ambulatory chemotherapy.
Indian Journal of Orthopaedics, 40 (3).
pp. 160-163.
ISSN Print: 0019-5413; Online; 1998-3727
Abstract
Background : Ambulatory chemotherapy is very effective in the
treatment of spinal tuberculosis, involving vertebral bodies, without
paraplegia. However, some patients with thoracic disease could
develop worsening of kyphosis. It would be helpful to predict
which patients were unlikely to develop severe kyphosis.
Methods : Step-wise discriminant analysis on the 10-year data
of 79 patients treated with ambulatory chemotherapy showed
that the angle of kyphosis on admission and the site of the lesion
were associated with an angle of 50 0 or less at 10 years. An
equation based on these factors was evolved to give a discriminant
function (D) value.
Results : Of 51 patients with an angle of 50 0 or less at 10 years,
47 had a D value of 0.499 or less, giving a predictive accuracy of
92%. Of 28 patients who had an angle of more than 500 at 10
years, 5 had a D value of 0.499 or less (false-negativity of 18%).
Considering the initial angle, which was much more important
(p<0.0001) than the site of the lesion (P<0.03), 46 of the patients
with an angle of 500 or less at 10 years had an initial angle of 300
or less (predictive accuracy of 90%); 3 of the patients who had an
angle of more than 500 at 10 years had an initial angle of 300 or
less (false-negativity of 11%).
Conclusion : If the angle of kyphosis on admission is 300 or less,
ambulatory chemotherapy could be confidently prescribed. The
method is reliable and simple.
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