In Reply: Paralysis Developing as a Paradoxical Response During the Treatment for Tuberculous Spondylitis

diagnosis, the orthopedic surgeon recommended an operation (anterior debridement and fusion) for the patient with vertebral collapse [1]. However, the patient refused the surgery and wanted to receive conservative treatment. Kotil et al. [2] reported that 44 patients with tuberculous spondylitis were managed conservatively with antituberculous medication and spinal orthosis. Exclusion criteria were major motor deficit, deteriorating neurologic function, or spinal deformity greater than 30o at the affected level of spine. Forty-two patients (95.4%) were treated well without any progression of the spinal deformity. Consequently, the authors suggested indications for surgery in tuberculous spondylitis with the following conditions: 1) gross neurologic impairment and instability or deformity, 2) treatment failure, 3) neurologic deterioration, 4) paradoxical response, or 5) intolerance to anti-tuberculous medication. Additionally, Zhang et al. [3] suggested that there was no significant difference in the outcomes between the In Reply: Paralysis Developing as a Paradoxical Response During the Treatment for Tuberculous Spondylitis Jae Hyeon Park, MD, Yeo Hyung Kim, MD, Chan Hyuk Kwon, MD, Hyung-Ik Shin, MD