The Clinical Treatments Of Recurrent Complex Spinal Tuberculosis Accompanied With Sinus Tract Formation

The Recurrent complex spinal tuberculosis accompanied with sinus tract formation is one of the most common and complex type of recurrent tuberculosis.To date,only very few studies reported the strategy of surgical treatments and effectiveness on the postoperatively recurrent spinal tuberculosis accompanied with sinus tract formation.Objectives: This study aims: 1)to summarize the reasons of postoperative recurrence of spinal tuberculosis and sinus tract formation;and 2)to summarize the strategy and clinical prognosis of surgical treatments for postoperative recurrence of spinal tuberculosis accompanied with sinus tract formation.Methods: In this study,26 recurrent patients in 98 patients with complex spinal tuberculosis were reviewed.The data of the patients,including age,gender,existence of drug resistant mycobacterium tuberculosis,postoperative standard chemotherapy,completeness of lesion debridement,reconstruction of the spinal stability,nutritional status,accompany of tuberculosis at other sites,timing of operation,and areas of lesion,were collected for the single and multiple factor analyses.All patients underwent the one-stage sinus tract resection,lesion debridement,bone graft fusion and internal fixation operation,and individualized chemotherapy.The clinical outcomes were evaluated by long-term follow-ups.Results: The clinical outcomes were evaluated by long-term follow-up.The results showed that 7 factors were significantly associated with postoperative recurrence of complex spinal tuberculosis accompanied with sinus tract formation.This suggests that when we treat complex spinal tuberculosis,we should pay more attention to these seven indicators to avoid postoperative recurrence,and our clinical outcomes suggest it is difficult for treating recurrent complicated spinal tuberculosis combined with sinus tract.However,one-stage operation combine pre-operation and post-operation personnel chemotherapy can lead to a good clinical outcome.Conclusion: Factors including the existence of drug resistant mycobacterium tuberculosis,un-standard postoperative chemotherapy,incomplete lesion debridement,failure of the reconstruction of spinal stability,malnutrition,accompany of tuberculosis at other sites,and bad timing of operation were significantly associated with postoperative recurrence of complex spinal tuberculosis accompanied with sinus tract formation.We should improve our understanding about spinal tuberculosis and treatment methods,and perform aggressive anti-tuberculosis treatment against drug resistant mycobacterium tuberculosis.After eliminate the mixed infection,patients who undergo the one-stage sinus tract resection,lesion debridement,bone graft fusion and internal fixation operation,and individualized chemotherapy which will be obtained under the guide of the drug sensitivity tests can get a good clinical outcome.