In Reply: Paralysis Developing as a Paradoxical Response During the Treatment for Tuberculous Spondylitis

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Ann Rehabil Med. 2015;39(2):329-329
Publication date (electronic) : 2015 April 24
doi :
Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea.
Corresponding author: Hyung-Ik Shin. Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 463-707, Korea. Tel: +82-2-2072-3218, Fax: +82-2-743-7473,

We appreciate your valuable comments. At the time of diagnosis, the orthopedic surgeon recommended an operation (anterior debridement and fusion) for the patient with vertebral collapse [1]. However, the patient refused the surgery and wanted to receive conservative treatment.

Kotil et al. [2] reported that 44 patients with tuberculous spondylitis were managed conservatively with anti-tuberculous medication and spinal orthosis. Exclusion criteria were major motor deficit, deteriorating neurologic function, or spinal deformity greater than 30° at the affected level of spine. Forty-two patients (95.4%) were treated well without any progression of the spinal deformity. Consequently, the authors suggested indications for surgery in tuberculous spondylitis with the following conditions: 1) gross neurologic impairment and instability or deformity, 2) treatment failure, 3) neurologic deterioration, 4) paradoxical response, or 5) intolerance to anti-tuberculous medication.

Additionally, Zhang et al. [3] suggested that there was no significant difference in the outcomes between the anti-tuberculous medication plus surgery and the medication alone, in a meta-analysis. However, there have been only two randomized controlled trials (331 patients) which were conducted in the 1970s and 1980s. Thus, a large, well-conducted, randomized controlled trial is needed to conclude the indications for surgery in tuberculous spondylitis.

Therefore, conservative treatment including anti-tuberculous medication and rigid thoracolumbosacral orthosis (TLSO) was chosen for the patient.


CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported.


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2. Kotil K, Alan MS, Bilge T. Medical management of Pott disease in the thoracic and lumbar spine: a prospective clinical study. J Neurosurg Spine 2007;6:222–228. 17355021.
3. Zhang X, Ji J, Liu B. Management of spinal tuberculosis: a systematic review and meta-analysis. J Int Med Res 2013;41:1395–1407. 24045167.

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