Efficacy analysis of reoperation for postoperative spinal tuberculosis with complicated infection

English Keywords:Spinal tuberculosis  Severe infection  Reoperation  Curative effect

English Abstract:

  【Abstract】 Objectives: To evaluate the efficacy and related risks of reoperation for spinal tuberculosis patients with severe infection after focal debridement. Methods: Retrospectively analyzed data of 18 patients who underwent revision surgery after focal debridement due tospinal tuberculosis infection from January 2006 to December 2018 in Beijing chest hospital affiliated to the Capital University of Medical Sciences. There were a total of 11 males and 7 females, aged 27-76(46.6±18.3) years. The follow up time ranged from 12 to 36 months, averaged 18.6±6.5 months. Complications, operation method, bacteria species, operation time, intraoperative blood loss, fusion status, Cobb angle changes preoperatively, 2 weeks after surgery and at the last follow-up were measured. Visual analogue scale(VAS), C-reactive protein, and erythrocyte deposition rate were also collected. Paraplegia status preoperatively and at the last follow-up were assessed using the American Spinal Injury Association(ASIA) injury scale. The surgical outcome and associated risks were then analyzed. Results: Among the 18 patients, 4 were infected with Staphylococcus aureus, 3 Escherichia coli, 2 Klebsiella pneumoniae, 2 Staphylococcus superficial, 2 Staphylococcus hemolyticus, 1 anaerobe, 1 Pseudomonas aeruginosa, 1 Enterobacter cloacae, and 2 Acinetobacter baumannii. 14 cases underwent posteriorsurgery and 4 underwent combined anterior and posterior surgery. Operation time ranged from 97 to 280 minutes and bleeding volume ranged from 100 to 1200ml. The patients were followed up for 12 to 36 months, with an average of 22 months. At 3 to 5 months after the operation, the fusion rate of bone graft was 100%. There were no obvious complications after reoperation in all patients. The average preoperative ESR was 45.6±25.8mm/h, CRP was 38.3±42.0mg/L, VAS score was 6.3±1.5, and Cobb angle was 15.3°±6.7°. At 2 weeks postoperatively, the mean values of those parameters were 30.3±11.0mm/h, 24.1±8.9mg/L, 2.4±1.2, and 12.6°±5.8°, respectively. At the final follow-up they were 14.2±9.6mm/h, 11.6±13.2mg/L, 1.8±1.1, and 12.8°±4.7°, respectively(P＜0.05). One ASIA grade B patient recovered to grade D after surgery, one ASIA grade C patient and four ASIA grade D patients reached grade E at the final follow-up. There was one case of ASIA D remained the status after the surgery. Conclusions: In patients with severe infection after spinal tuberculosis, reoperation canresult in good therapeutic outcome.