Letter to the Editor: Comprehensive spinal tuberculosis score: a clinical guide for the management of thoracolumbar spinal tuberculosis

Sanjay Singh Rawat; Pulkesh Singh; Gaurav Kumar Upadhyaya; Mithilesh Ranjan; Ajay Kumar Shukla

doi:10.31616/asj.2024.0123.r1

Dear Editor,

We read the article published by Sonawane et al. [1] with great interest, titled “Comprehensive spinal tuberculosis score: a clinical guide for the management of thoracolumbar spinal tuberculosis.” The authors have done commendable work to formulate a guide for the management of thoracolumbar spinal tuberculosis. However, we would like to get comments on some of our queries on these issues.

1. As per the scoring chart given by the author, shouldn’t the score range from 2 to 15, as in pain and destruction of vertebrae elements, the minimum score is 1?

2. At what regular interval, in cases where medical management is opted for, should the score be retaken? Pain, kyphosis angle (especially in children), and neurological status could change during anti-tuberculosis treatment (ATT), and an increasing kyphosis angle is documented during medical management, which could lead to neurological involvement [2].

3. Does the author suggest the same ATT duration in both medical and surgically treated cases, or does it differ as suggested by Wang et al. [3].

4. Does the author suggest that surgery should be done immediately in cases of a score >6.5, or would surgery be done after 2–4 weeks of ATT? [4]