High-sensitivity C-reactive Protein? Is It Significant in Tuberculous Spondylitis

Introduction: Spinal tuberculosis (TB) is a common entity in Asian subcontinent, occurring in the first three decades of life. TB of spine most commonly affects the dorsolumbar spine region followed by cervical spine. Early diagnosis and treatment are necessary to avoid long-term disability. Elevated erythrocyte sedimentation rate (ESR) and positive mantoux test provide supportive evidence for the diagnosis of TB but are not specific. Imaging of spine is the most important preliminary tool to make the diagnosis of TB spondylitis. Acid-fast bacilli smear and culture are not positive in all the cases. In this study, we have assessed the role of high-sensitivity C-reactive protein (hs-CRP) in the diagnosis of TB spondylitis and in monitoring the clinical response to treatment. Materials and Methods: This is a prospective study carried out in the Department of neurosurgery, Government General Hospital, Vijayawada, from July 2015 to February 2016. Patients with imageological features suggestive of TB of the spine were evaluated clinically, and blood samples were taken for measurement of hs-CRP. All these patients were evaluated clinically and radiologically and were correlated with inflammatory marker at the follow-up of for 3 months and 6 months. Results: A total of 56 patients were included in the study and control group. hs-CRP was raised in 70.96% and 32% of patients in study group and control group with statistically significant P = 0.004. Patients with elevated hs-CRP had a worser visual analogue scale score and neurological status (ASIA grade < C and NURICK grade > 2) as compared to patients with normal hs-CRP, but this correlation did not reach the level statistical significance. Conclusion: Elevated hs-CRP is a useful marker to supplement the diagnosis of TB of spine and monitoring the patients for the response to treatment. Elevated hs-CRP strongly correlates with vertebral body collapse and presence of soft tissue component in TB of spine. Larger clinical studies are required to validate this results of ours in endemic regions.