Efficacy of ultra-short-course chemotherapy on spinal tuberculosis after surgery, an over 5-year clinical outcome

English Keywords:Spine tuberculosis  Ultra-short-course chemotherapy  Efficacy  Thorough focus debridement

English Abstract:

  【Abstract】 Objectives: To explore the feasibility of over 5-year clinical outcome of ultra-short-course chemotherapy for spinal tuberculosis after thorough focus debridement. Methods: A prospective cohort study design, in accordance with the principles of randomized controlled trial was perfomed, from January 1998 to January 2007, 226 patients with spinal tuberculosis and indicated for surgery were included in this series. According to the duration of the chemotherapy, the patients were divided into two groups. The ultra-short-course chemotherapy group(group A, 137 cases) was treated for 4-6 months(average, 5.5 months) of 2SHRZ/2-4HRZ. The standard chemotherapy group(group B, 89 cases) was treated for 9-18 months(average, 12 months) of 2SHRZ/7-16HRZ. The age, sex, lesion site, number of spinal segments involving abscess, kyphosis Cobb angle, erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), ASIA score and the combined non-spinal tuberculosis showed no statistically significant difference between two groups(P>0.05). The same surgery was performed on patients in two groups. The DOTS program was adopted during treatment. The ESR, CRP, nerve function ASIA score, life quality and ability to work, loss of correction, bone graft and use of anti-TB drugs, the incidence of complications were observed at final follow-up. Results: The follow-up lasted 73-86 months(average, 79.4 months) for group A and 64-87 months(average, 70.3 months) for group B. ESR, CRP value and ASIA scores showed no significant difference between two groups before or after treatment. However, the aforementioned indexes showed significant difference(P<0.05). At final follow-up, the correction rate was 70.3%, while the loss rate of correction of 8.0% in group A and 68.2% and 7.6% in group B respectively, which showed no difference between two groups(P＞0.05). The average bone healing time for group A and group B was 4.6 months(range, 3.0-5.0 months) and 4.1 months(range, 3.0-5.0 months) respectively, which showed no difference between two groups(P＞0.05). At final follow-up, the bone healing rate was 100% in group A and 98.9% in group B, which showed no significant difference between two groups(P＞0.05). One patient abandoned chemotherapy because of acute renal dysfunction and had protracted disease. At final follow-up, 129/137 patients(94.2%) in group A, and 85/89 patients(95.5%) in group B returned to normal life and recovered the ability to work, which showed no difference between two groups(P＞0.05). Drug side effects occurred in 11(8.0%) patients in group A and 18(20.2%) patients in group B, which showed significant difference between two groups(P<0.05). 19 patients(13.9%) in group A and 6 patients(6.7%) in group B had chemotherapy extended, which showed significant difference between two groups(P<0.05). Conclusions: Ultra-short-course chemotherapy present the similar efficacy as standard chemotherapy for the spinal tuberculosis after a clinical observeration of more than 5 years. Ultra-short-course chemotherapy after thorough debridement for spinal tuberculosis is feasible and less side effects.