Abstract
Purpose
To determine the outcome and safety of surgical treatment of thoracic and lumbar spinal tuberculosis in patients without obvious clinical and laboratory improvement after preoperative short-time chemotherapy.
Methods
Data of 86 patients with single-level thoracic and lumbar tuberculosis, treated by one-stage posterior instrumentation combined with anterior radical debridement and fusion, were studied retrospectively. Patients were divided into two groups based on the results of erythrocyte sedimentation rate (ESR) after preoperative 2-week chemotherapy. Surgical outcome and prognosis were compared between the two groups.
Results
After antituberculous chemotherapy for 2 weeks, the ESR did not decrease or even increase in 57 patients (group A), but decreased in 29 patients (group B). However, the ESR decreased gradually after surgery and returned to a normal level at the final follow-up in both groups. Between group A and B, no significant difference was observed in pain improvement (6.3 ± 1.4, 6.4 ± 1.4, respectively, P = 0.805). The corrected angle was 12.4° ± 5.9°, 13.8° ± 6.4°, respectively, for group A and group B (P = 0.305).
Conclusions
It is safe and effective to carry out the surgery just after a short-time antituberculous chemotherapy. And it is the postoperative drugs, not the preoperative drugs, that play an important role in reinforcing the surgical outcome.
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References
Trecarichi EM, Di Meco E, Mazzotta V et al (2012) Tuberculous spondylodiscitis: epidemiology, clinical features, treatment, and outcome. Eur Rev Med Pharmacol Sci 16(S2):58–72
Boachie-Adjei O, Papadopoulos EC, Pellisé F et al (2013) Late treatment of tuberculosis-associated kyphosis: literature review and experience from a SRS-GOP site. Eur Spine J 22(S4):641–646
Jain A (2010) Tuberculosis of the spine a fresh look at an old disease. J Bone Joint Surg Br 92(7):905–913
Frankel H, Hancock DO, Hyslop G et al (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia 7(3):179–192
Wang B, Lv G, Liu W, Cheng I (2011) Anterior radical debridement and reconstruction using titanium mesh cage for the surgical treatment of thoracic and thoracolumbar spinal tuberculosis: minimum 5-year follow-up. Turk Neurosurg 21(4):575–581
Rajasekaran S, Soundarapandian S (1989) Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis. J Bone Joint Surg Am 71(9):1314–1323
Wang Z, Yuan H, Geng G, Shi J, Jin W (2012) Posterior mono-segmental fixation, combined with anterior debridement and strut graft for the treatment of mono-segmental lumbar spine tuberculosis surgeries. Int Orthop 36(2):325–329
Kim KS, Ko SH, Youm KS, Choi CH, Yang JH (1998) Anterior spinal instrumentation in treatment of spinal tuberculosis. J Korean Orthop Assoc 33(6):1560–1568
Ma YZ, Cui X, Li HW, Chen X, Cai XJ, Bai YB (2012) Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults. Int Orthop 36(2):299–305
Cui X, Ma YZ, Li HW, Chen X, Cai XJ, Bai YB, Guo LX, Xue HB (2012) Outcomes of anterior versus posterior instrumentation under different surgical procedures in the treatment of thoracolumbar spinal tuberculosis in adults. Zhong Hua Yi Xue Za Zhi 92(19):1325–1329
Zhang HQ, Li JS, Zhao SS, Shao YX, Liu SH, Gao Q, Lin MZ, Liu JY, Wu JH, Chen J (2012) Surgical management for thoracic spinal tuberculosis in the elderly: posterior only versus combined posterior and anterior approaches. Arch Orthop Trauma Surg 132(12):1717–1723
Pang X, Wu P, Shen X, Li D, Luo C, Wang X (2013) One-stage posterior transforaminal lumbar debridement, 360° interbody fusion, and posterior instrumentation in treating lumbosacral spinal tuberculosis. Arch Orthop Trauma Surg 133(8):1033–1039
He B, Hu Z, Hao J, Liu B (2012) Posterior transpedicular debridement, decompression and instrumentation for thoracic tuberculosis in patients over the age of 60. Arch Orthop Trauma Surg 132(10):1407–1414
Pang X, Shen X, Wu P, Luo C, Xu Z, Wang X (2013) Thoracolumbar spinal tuberculosis with psoas abscesses treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage. Arch Orthop Trauma Surg 133(6):765–772
Zhang H-Q, Lin M-Z, Ge L, Li J-S, Liu J-Y, Wu J-H (2012) Surgical management by one-stage posterior transforaminal lumbar debridement, interbody fusion, and posterior instrumentation for lumbo-sacral tuberculosis in the aged. Arch Orthop Trauma Surg 132(12):1677–1683
Zhang H-Q, Lin M-Z, Li J-S, Tang M-X, Guo C-F, Wu J-H, Liu J-Y (2013) One-stage posterior debridement, transforaminal lumbar interbody fusion and instrumentation in treatment of lumbar spinal tuberculosis: a retrospective case series. Arch Orthop Trauma Surg 133(3):333–341
Gong K, Wang Z, Luo Z (2011) Single-stage posterior debridement and transforaminal lumbar interbody fusion with autogenous bone grafting and posterior instrumentation in the surgical management of lumbar tuberculosis. Arch Orthop Trauma Surg 131(2):217–223
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Zhang, P., Shen, Y., Ding, WY. et al. The role of surgical timing in the treatment of thoracic and lumbar spinal tuberculosis. Arch Orthop Trauma Surg 134, 167–172 (2014). https://doi.org/10.1007/s00402-013-1904-5
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DOI: https://doi.org/10.1007/s00402-013-1904-5