Efficacy of 3-4.5 months ultra-short-course chemotherapy on spinal tuberculosis after thorough focus debridement

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

English Abstract:

  【Abstract】 Objectives: To observe the efficacy of 3-4.5 months ultra-short-course chemotherapy after thorough focus debridement in the treatment of spinal tuberculosis, and to explore the feasibility of 3-4.5 months ultra-short-course chemotherapy for spinal tuberculosis after thorough focus debridement. Methods: In December 2003 to December 2014, 116 patients with spinal tuberculosis after thorough focus debridement treated with 3-4.5 months of chemotherapy were reviewed retrospectively. There were 60 males and 56 females, the average age of patients was 40.98±17.09 years(range, 3 to 78 years). Presentations included fever in 31 cases, night sweats in 47 cases, fatigue in 53 cases, local pain of lesions in 113 cases, abscess in 78 cases, anorexia and weight loss in 43 cases, neurological dysfunction in 38 cases, thoracolumbar kyphosis in 33 cases. Involved levels included cervical lesions in 1 case, cervicothoracic lesions in 1 case, thoracic lesions in 39 cases, thoracolumbar lesions in 17 cases, lumbar lesions in 48 cases,lumbosacral lesions in 9 cases, sacral lesions in 1 case. Involved segments included single segment in 87 cases, double segments in 19 cases, more than 3 segments in 10 cases. Preoperative SHRZ quadruple anti tuberculosis treatment was used for 2 to 4 weeks(average, 3.2 weeks). Debridement was performed in all cases, among these, anterior approach was used in 37 cases, posterior approach was used in 9 cases. The ultra-short-course chemotherapy was 2SHRZ/1-2.5HRZ after operation. Postoperative observation indexes included: clinical manifestation, nerve function Frankel grade, erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), lesion clearance, correction of deformity, bone graft fusing and lesion healing, the incidence of complications of anti-TB drugs. Withdrawal indicators: ①patients with no spinal tuberculosis symptoms or signs, no local abscess and fistula formation; ②the ESR and CRP were normal; ③no abscess associated with spinal tuberculosis was found by B ultrasonic examination; ④imaging examination showed that the lesions were all cured, no new lesion, bone graft fusion. Results: The course of treatment in 116 patients was 3-4.5 months，with an average of 3.89±0.60 months. Follow-up time(2-13 years): ＜3 years in 20 cases, 3 to 5 years in 15 cases, more than 5 years in 81 cases. Among withdrawal patients, 116 patients had no tuberculosis poisoning symptom, no local pain and local abscess and fistula, all patients reached recovery of life and work ability, the lesions were thoroughly debrided, bone graft fusion was reached. 1 case of patients with lumbar vertebral tuberculosis was cured after the treatment of 4 months and got, recurrence at 6 years after drug withdrawal, then underwent reoperation with anterior debridement and lliac bone graft, cured with postoperative anti-tuberculosis after 24 months. The preoperative Cobb angle of 33 cases of thoracolumbar kyphosis was 28.46°±7.19°(19°-42°), postoperative Cobb angle was 15.30°±5.13°(3°-25°), Cobb angle at the last follow-up was 18.63°±6.06°(10-36°), the correction rate was 46.2%, the loss of rate was 11.8%, deformity correction was satisfactory. At the end of the last follow-up, neurologic Frankel grade of preoperation recovered obviously, 1 case with grade A recovered to grade C, 1 case with grade B recovered to grade D, 8 cases with grade C recovered to grade D in 1 case and grade E in 7 cases, 28 cases with grade D recovered to grade E. Chemotherapy related complications occurred in 17 cases. Conclusions: On the basis of thorough focus debridement, under strict indications and supervision of chemotherapy, 3-4.5 months ultra-short-course chemotherapy for spinal tuberculosis is feasible.