The causes and clinical treatments of recurrent spinal tuberculosis complicated with sinus tract / 中华骨科杂志

ABSTRACT

Objective To explore the causes and clinical treatments of recurrent spinal tuberculosis complicated with sinus tract.Methods There were 21 patients suffered from recurrent spinal tuberculosis complicated with sinus tract in 87 patients with complicated spinal tuberculosis from January 1997 to January 2012.The dates of them were reviewed.There were 12males and 9 females with an average age of 38.8 years (range,22-58 years).There were 15 patients whose tuberculosis bacterial culture and drug sensitive experiments suggested drug resistance.All patients were excluded from mixed infection of sinus before the operation.According to the range of the tuberculous abscess,11 patients had undergone one stage sinus clearing and debridement,instrument removal,spinal fusion and internal fixation by anterior approach.The other 10 patients had undergone one stage anterior sinus clearing and debridement,instrument removal,bone graft and internal fixation by posterior approach.Results All patients were followed up for an average time of 29.7 months.16 patients were recovered.5 patients got recurrence with the rate of 23.8％(5/21).The recurrence rate of anterior internal fixation was 18.2％(2/11),and 30％ (3/10) for posterior internal fixation.3patients got recovered by conservative treatment and 2 patients by re-debridement.15 patients achieved bone fusion 6 months after the operation; 4 patients achieved bone fusion 9 months after the operation; 1 patient achieved bone fusion 12 months after the operation.The kyphosis Cobb' angle was corrected to 5.7°(ranged from 2° to 12°).Conclusion It is difficult for the treatment of recurrent complicated spinal tuberculosis combined with sinus tract.The causes of recurrence include drug-resistant strains of TB,uncompleted debridement,failure of spinal stability reconstruction,and combination with other organ tubeculosis.The key of successful surgical treatment includes effective chemotherapy,radical debridement and proper reconstruction of spinal stability.