Long Term Effects Of Surgery Combined With Pre-and Post-operative Chemotherapy In Treating Spinal Tuberculosis

Background:Tuberculosis(TB)of the spine is one of the most common sites of osseous TB,accounting for 50%-60% of cases.Spinal TB still occurs in both developed and developing countries.The diagnosis of spinal TB is tremendously uneasy,therefore it usually presents at an advanced stage.Most of them need to be surgically intervened.Since 1950,Orthopedic Hospital of Tianjin firstly started debridement surgery,various focal debridement surgeries have been widely implemented in clinic,short term effects have been achieved to most of them,however,long term effects have rarely been reported.Objective:To investigate long term effects of Surgery combined with pre-and post-operative chemotherapy in treating spinal tuberculosis.Method:We retrospectively and electronically searched 39 patients(17male,22female)with spinal tuberculosis treated with surgery and pre-and post-operative chemotherapy in The First Affiliated Hospital of Dalian Medical University,these patients were admitted from 2007.04 to 2012.04.We than compared pre-,post-operative and last follow up visual analogue scale(VAS),erythrocyte sedimentation rate(ESR),C-reaction protein(CRP),kyphotic Cobb,ASIA and changes of the radiological results.Results: The toxic symptoms of tuberculosis to all patients were relieved after at least two weeks anti-tuberculosis therapy pre-operatively,all met the qualification of surgery.Patients were divided into three groups:Simple anterior route13(male6,female7),mean age(42.5±7.4);Simple posterior route19(male8,female11),mean age(43.5±8.3)and anterior debridement bone graftingcombined with posterior infusion route7(male3,female4),mean age(42.8±5.6).Symptoms of spinal tuberculosis and back pain to all patients were disappeared post-operatively;Compared pre-operatively,VAS were significantly decreased after surgery,VAS continuously to be improved on last follow up,P<0.05;On five year follow up ASIA were significantly improved,P<0.05;Debridment+spinal fusion rate was 100%,Kyphotic Cobb were significantly changed,P<0.05;Compared pre-operatively,post-operative and last follow up,erythrocyte sedimentation rate(ESR)and C-reaction protein(CRP)were significantly recovered,P<0.05.There were one complication of infection,one complication of pneumonia and one complication of spinal fluid leakage(which were all conservatively and successfully managed).Conclusion:Surgical approach is one of the adjuvant therapies in treating spinal tuberculosis,full and effective anti-tuberculosis chemotherapy is fundamentally important.Surgeons should deeply understand different surgical indications and contraindications,take patients' general condition and specific illness into consideration,so as to choose a suitable surgical way in treating spinal tuberculosis,it is tremendously imperative to patients with spinal tuberculosis.After receiving surgery combined with pre and post-operative chemotherapy,VAS,CRP,ESR,kyphotic Cobb and AISA would be significantly improved.Meanwhile,with satisfactory long term effects.