Thoracolumbar tuberculosis: implications for appropriate management based on disease location and proposal of a novel scoring system
Objective: To identify factors indicating disease severity in patients with thoracolumbar tuberculosis requiring surgical intervention. 
Design: Medical charts of patients who underwent surgery for thoracic and lumbar spinal tuberculosis from 1990-2005 were reviewed. Patients with different levels of disease were compared in terms of neurological deficits, duration of symptoms, previous antituberculous therapy, nutritional status and associated co-morbids. 
Results: Ninety-three patients aged 7-77 years (mean age 40 years) were included. Thoracic spine was involved in 80% of operated patients, and lumbar spine in 20%. Severe neurological impairment (Frankel A to C) was present in 68% of patients with thoracic disease, as compared to 5% with lumbar disease (p<0.05). Postoperatively, complete neurological recovery occurred in 65% with thoracic versus 100% with lumbar disease (p<0.05). Based on the disease location and pertinent elements in clinical history, physical signs, radiographic and biochemical features, a scoring system was developed. 
Conclusion: In endemic areas with limited resources, strategies for cost-effective care are needed. By objectively outlining the treatment approach, the judicious use of surgery offers hope for enormous cost savings in countries endemic for tuberculosis, averting complications from disease progression.