Randomized controlled trial of vitamin d supplementation on toll-like receptor-2 (tlr-2) and toll-like receptor-4 (tlr-4) in tuberculosis spondylitis patients

BACKGROUND

Tuberculosis spondylitis accounts for approximately 50% of all cases of skeletal tuberculosis. Vitamin D plays a role in the immune system. Vitamin D helps in the activation of TLR-2 and TLR-4, which play a role in the process of tuberculosis infection. The objective of this study was to investigate the effect of oral supplementation with vitamin D on TLR-2 and TLR-4 levels in tuberculosis spondylitis patients.

METHODS

The true Experiment Design Pretest-Posttest with Control Group (Pretest-Posttest with Control Group) was used for this research. TLR-2 and TLR-4 were measured by ELISA. Repeated ANOVA, ANOVA tests, and Kolmogorov-Smirnov normality tests on the SPSS program were used to statistically analyze the results.

RESULT

In the dose groups of 10,000 IU and 5000 IU, significant increases in the levels of vitamin D, TLR-2, and TLR-4 were observed at weeks 4 and 8 (p < 0.05). In the control group, there was no significant increase.

CONCLUSIONS

Vitamin D supplements can significantly increase TLR-2 and TLR-4 levels. Supplementation with vitamin D 10,000 IU/day for 8 weeks can increase vitamin D levels > 50 ng/dl to optimally act as an immunomodulator.

Neurological recovery after early decompression for dorsal Pott's spine

INTRODUCTION

Tuberculosis spondylitis or Pott's disease is the most common destructive form of skeletal tuberculosis. The most commonly affected site is the thoracolumbar vertebra. Once invading the adjacent structures of the vertebrae and intervertebral discs ultimately form an abscess causing spinal cord compression, vertebral collapse, and severe kyphotic deformity.

PRESENTATION OF CASE

We present the first-ever case done in King Fahd Military Medical Complex in Dhahran, Saudi Arabia, of an 18-year-old male diagnosed with tuberculosis spondylitis who was complaining of progressive upper back pain and lower limb weakness. Emergent anterior decompression with expandable cage, plates, and screws were done. The patient showed a smooth and rapid recovery and was discharged with improved lower limb power and sensations.

DISCUSSION

Pott's disease can lead to progressive neurological deficits in which surgical decompression is indicated. Current surgical practice includes anterior or posterior decompression with or without fusion and/or instrumentation.

CONCLUSION

Surgery with either anterior or posterior decompression should assure complete clearance of the lesion, correcting the kyphotic deformity that prevents disease progression.