SHORT-COURSE CHEMOTHERAPY IN THE TREATMENT OF POTTS-PARAPLEGIA - REPORT ON 5-YEAR FOLLOW-UP

OBJECTIVE: To assess the efficacy of 9-month short-course chemotherapy (SCC) and to study the pattern of neurological recovery in patients w ith Pott's paraplegia. DESIGN: Patients with recent onset of spastic p araplegia due to clinically and radiologically active spinal tuberculo sis involving vertebral bodies of level D4-L1 were treated with strept omycin, rifampicin, isoniazid and ethambutol daily for the first 2 mon ths, followed by rifampicin plus isoniazid twice weekly for the next 7 months. The study was conducted in 2 phases. In the first phase 10 pa tients were admitted to the open trial where all patients had undergon e modified Hong Kong surgery in addition to chemotherapy. In the next phase 23 patients enrolled in the study were randomly allocated to rec eive either chemotherapy alone or surgery plus chemotherapy. All the p atients were followed for 5 years from the start of treatment. A scori ng system was devised to predict neurological recovery. RESULTS: In al l, 33 patients were admitted and treated with SCC. Thirteen patients w ere allocated to the chemotherapy (CHEM) regimen; of these 3 patients had to be operated upon for clinical deterioration; the remaining 20 h ad surgery plus chemotherapy; 4 were excluded for various reasons, lea ving 29 patients in the analysis. None relapsed requiring treatment. C ONCLUSION: A combination of surgery (when indicated) and SCC of 9 mont hs' duration is effective in the treatment of Pott's paraplegia. All p atients had neurological recovery by the end of 9 months; 8 recovered with chemotherapy alone. Complete motor recovery was seen in 62% by th e 3rd month and 90% by the 6th month.