Comparison between surgical and conservative management of tuberculous spondylodiscitis at University Teaching Hospitals of Kinshasa and Kisangani in the Democratic Republic of the Congo.

BACKGROUND

Pott's disease remains a serious condition, particularly in low-income countries where treatment is often limited to conservative methods. This study aimed to compare the effectiveness of surgical and conservative treatments in patients with Pott's disease.

METHODS

A prospective cohort study was conducted involving 54 patients treated for Pott's disease between January 1, 2020, and December 31, 2023. The American Spinal Injury Association (ASIA) and Spinal Cord Independence Measure (SCIM) scores were used to assess treatment outcomes. The difference-in-difference (Diff-in-Diff) method was applied to evaluate score changes from admission to 12-month follow-up. The average treatment effect on the treated (ATET) was calculated, adjusting for age and gender, using a significance level of 0.05.

RESULTS

Among the 54 patients (80 % female, median age 44), 31 (57.4 %) received conservative treatment and 23 (42.6 %) underwent surgery. At baseline, the two groups were similar in demographics and disease characteristics, though the surgical group had more severe spinal cord injury. After 12 months, ASIA scores were similar between groups (score difference = 0.015; p = 0.950), suggesting no significant advantage of surgery. SCIM scores were also comparable (score difference = 0.146; p = 0.977). However, the Diff-in-Diff coefficient for SCIM indicated a statistically significant benefit in the surgical group (p = 0.013).

CONCLUSION

Time was a key factor in recovery regardless of treatment type. Surgery showed potential benefits, particularly in patients with more severe initial impairment, though further research with a larger cohort is needed to confirm these findings.