====== Tuberculous vertebral osteomyelitis treatment ======


Esposito et al., highlighted the importance of suspecting this disorder in children with both aspecific systemic and neurological symptoms, in order to reach a timely diagnosis for appropriate and targeted intervention, avoiding the risk of overtreatment and malpractice claims
((Esposito S, Moscatelli M, Schiariti MP, Viganò I, Pantaleoni C, Marucci G.
Pott's Disease: An Emerging Source of Potentially Inappropriate Treatment.
Neuropediatrics. 2019 May 29. doi: 10.1055/s-0039-1691833. [Epub ahead of print] 
PubMed PMID: 31141827.
)).

In the context of evidence-based medicine and the rational use of antibiotics, it is clear that antibiotics should be preferred according to the culture antibiogram results in the treatment of infectious diseases
((Dogan M, Simsek AT, Yilmaz I, Karaarslan N. Evaluation of Empirical Antibiotic
Treatment in Culture Negative Pyogenic Vertebral Osteomyelitis. Turk Neurosurg.
2019 Jan 2. doi: 10.5137/1019-5149.JTN.25018-18.2. [Epub ahead of print] PubMed
PMID: 31049918.
)).

===== Surgery =====

In [[1910]], Taylor 
((Taylor AS. X. Unilateral Laminectomy. Ann Surg. 1910;51:529–33.)) 
described the [[hemilaminectomy]] technique.

Posterior lateral mass fusion was later added to Albee
((Albee F. Transplantation of a portion of the tibia into the spine for Pott’s disease: a preliminary report. JAMA. 1911;57:885.))
and Hibbs’s technique in [[1911]] 
(( Hibbs RA. An operation for progressive spinal deformities. NY Med J. 1911;93:1013–6.))
, which remained the standard for 5 decades. This was first utilized for instability in patients with [[Pott’s disease]].

Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. 

The role of surgical debridement and fusion with TB is controversial, and good results may be obtained with either medical treatment or surgery. Surgery may be more appropriate when definite cord compression is documented or for complications such as abscess or sinus formation 
((Medical Research Council Working Party on Tuber- culosis of the Spine. Controlled Trial of Short- Course Regimens of Chemotherapy in the Ambula- tory Treatment of Spinal Tuberculosis: Results at Three Years of a Study in Korea. J Bone Joint Surg. 1993; 75B:240–248))
or spinal instability.