| BackgroundTuberculosis(TB) is a major public-health problem in developing countries. The Asia-Pacific region has the largest TB burden, especially in China. Detecting the disease and curing it is one of the important interventions for addressing health inequity. In recent years, TB control efforts have taken on increased urgency due to the emergence of multidrug-resistant TB(MDR-TB), a form of the disease that is resistant to frontline drugs, and extensively drug-resistant TB(XDR-TB), which is also resistant to some second-line drugs. MDR-TB has emerged in nearly every country in the world, with 480,000 people developed multidrug-resistant tuberculosis(MDR-TB) in the world in 2014. These forms of the disease are especially difficult and costly to treat and are a consequence of years of inadequate diagnosis and treatment. China accounts for nearly 11 % tuberculosis burden of the world, it’s second to India in the number of TB patients. WHO declared tuberculosis a worldwide emergency in 1993, Since then, spinal tuberculosis as a common form of extrapulmonary tuberculosis in china, has resurged after decades of decline in incidence. According to a large sample study of extrapulmonary tuberculosis, spinal tuberculosis represents at least 1.2% of all MDR-TB infections and the new cases of it substantially increased in recent years. Standard antituberculosis chemotherapy is the cornerstone in the management of spinal tuberculosis. For some proper selected patients, radical surgery maybe the most effective management to shorten the duration, restore spinal stability, preserve and restore neurological function. While the outcomes of some patients underwent surgery were not so good,sometimes these failed surgeries needed revision or several surgeries. Drug resistance,inadequate chemotherapy,inappropriate surgery may lead to failure in management of spinal tuberculosis. Considering the power of MDR-TB, we need to do more search to unravel the complicated reasons of it to cure people and end the TB epidemic.ObjectiveTo analyze the main causes of reoperation of spinal tuberculosis, meanwhile discuss treatment options for spinal tuberculosis to improve the cure rate of it.Methods We retrospectively analysed 861 patients who were enrolled from Jan 2000 to Dec 2012 in our department with spinal tuberculosis and had an operation. 71 patients who had a second surgery due to the resurgence of tuberculosis were divided as relapse group, including 42 males, 29 females. In this group, the age of the first surgery range from 5 to 72(34.3 for an average)years old and the clinical course range from 0.5 to 516 months. According to the gender, the one to one matched patients are in the relapse group. The relationship of risk factors and the incidence of recurrence was determined by SPSS. 71 patients had individualized surgery: 4 cases were radical debridement and drainage surgeries, 16 were radical debridement surgeries, 11 were Single-stage anterior focal debridement, fusion and instrumentation, 24 were Single-stage posterior focal debridement, fusion and instrumentation, 4 were Single-stage posterior instrumentation followed by anterior focal debridement, 5 were Two-stage posterior instrumentation followed by anterior focal debridement and 7 were CT-guided percutaneous catheter drainage and local chemotherapy.ResultsNo neurological, major vascular injuries or other complications were observed. The time of follow-up ranges from 18-108(28 for an average) months. Depending on Bridwell criteria, 62 cases had definitely fusion, 5 cases had bone bridge between the adjacent vertebraes and 4 cases failed.ConclusionThe reasons of recurrence of spinal tuberculosis after surgery have related with drug-resistant and irregular chemotherapy, so the reoperation should be an individualized surgery. Thus, combined with regular chemotherapy after reoperation, the recurrence of spinal tuberculosis can be controlled effectively. |
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