Treatment Of Spinal Tuberculosis By CT-guided Percutaneous Catheter Drainage And Lumbosacral Tuberculosis By One-stage Anterior Surgery

BackgroundAccording to the WHO Global tuberculosis report 2015, about 1.3 million Chinese suffer from tuberculosis each year, accounting for 14.3% of global tuberculosis patients,with the incidence ranking only after Indian the world. Similar to other countries, the incidence of extra-pulmonary tuberculosis in China, especially the bone and joint tuberculosis, is also high. Of the bone and joint tuberculosis, 90% secondary to pulmonary tuberculosis, the most common type is spinal tuberculosis. Treatment of typical spinal tuberculosis, conservative or surgical, was massively reported, but there have been few studies on the minimally invasive surgery. Furthermore, surgical treatment of tuberculosis at special parts or with special types still remains to be explored. Therefore, this project aims to investigate the treatment of spinal tuberculosis by CT-guided percutaneous catheter drainage and lumbosacral tuberculosis by one-stage anterior surgery.The treatment of tuberculosis has undergone a significant change since the emergence of anti-tuberculosis drugs,with the cure rate further improved especially by surgery.However, there rises controversy on application of the surgery as there were abuses for some reason. To solve this problem, in the first part of this project, we try to explore a new less invasive approach to treating spinal tuberculosis, CT-guided percutaneous catheter drainage which is between conservative treatment and surgery.Surgical treatment of typical spinal tuberculosis has been extensively studied but reports on the treatment of lumbosacral tuberculosis, which accounts for 2%-3% of spinal tuberculosis, were relatively fewer. Therefore, in the second part of this project, we endeavor to invent a new surgical treatment of lumbosacral tuberculosis by one-stage anterior debridement with allograft and anterior instrumentation.We hope our research will provide new ideas for treating spinal tuberculosis.ObjectiveThis study was designed to explore a new approach in the treatment of spinal tuberculosis trough probing into treating spinal tuberculosis by CT-guided percutaneous catheter drainage and treating lumbosacral tuberculosis by one-stage anterior debridement with allograft and anterior instrumentation.MethodsFrom April 2009 to October 2012, a total of 48 cases (27 males, 21 females)with spinal tuberculosis with a mean age of 30 years (range, 18-74 years) were included in this study, which was onindividualized chemotherapy for spinal tuberculosis by CT-guidedpercutaneous catheter drainage. From July 2001 to December 2011, a total of 43 cases(20 males, 23 females) with lumbosacral tuberculosis with a mean age of 30 years(range, 18-74 years), were included in this study, which was on surgical treatment of lumbosacral tuberculosis by one-stage anterior debridement with allograft and anterior instrumentation. The clinical observation, laboratoryinspection, imaging studies and complications before and after the treatment was compared to assess the clinical efficacy.ResultsThe 48 cases with spinal tuberculosis who received individualized chemotherapy by CT-guidedpercutaneous catheter drainage were followed up for 36 months, during which the original lower back pain and neurological symptoms were found to be significantly alleviated. The 43 cases with lumbosacral tuberculosis who received surgery by one-stage anterior debridement with allograft and anterior instrumentation were follow-up for 34 months. All the clinical symptoms were found to disappear at the end of the follow-up, with no case of reservation.ConclusionThe individualized chemotherapy by CT-guidedpercutaneous catheter drainage has an obvious advantage over conservative treatment in treating spinal tuberculosis. Though it doesn't apply to all the patients, it can serve as an important supplement for the surgery and conservative treatment.There exist a few disadvantages in the one-stage anterior-surgery, but it is still a useful method to treat lumbosacral tuberculosis, worth applying in the clinic.