The causes and surgical strategy of spinal tuberculosis retreatment / 中华骨科杂志

ABSTRACT

Objective To investigate the causes of spinal tuberculosis retreatment and its surgical treatment strategy.Methods Between May 2010 and May 2014,96 patients with spinal tuberculosis who had been operated before were retreated.The dates of them were reviewed.There were 51 males and 45 females with mean age of 39.7 years.Deciding upon the revision surgical procedure should be determined by last operation approach,the direction of compression of spinal cord,the position of sinus and extent of foci.The retreated patients were compared with 481 unretreated patients in the following index including sex,age,duration of disease,focus range,nutrition,drug resistant tuberculosis,debridement,stability of instrumentation,postoperative regular chemotherapy,associated tuberculosis.Results The surgery duration time was 160-280 min,average 210 min,and the blood loss was 400-1500 ml,average 600 ml.The VAS score before the operation was 6-9 (average 7.5) and 1-3 (average 1.5) at the last follow-up,the difference was statistically significant.Neurological deficits in 21 patients clinically improved at least one grade according to the ASIA grading system at last follow-up.Kyphosis and scoliosis degrees were corrected significantly postoperatively and the correction was 9.5°±3.6° at the final follow-up.The average angle loss was 3.5°±1.1°.There was significant difference between the kyphosis angles preoperatively,postoperatively and final follow-up.Kirkaldy-Willis function score showed that the total fine rate was 88％.There were 35 patients whose tuberculosis bacterial culture and drug sensitive experiments suggested drug resistance.Wound healing delayed in 7 patients.24 cases had sinus formation,13 cases in which were healed after wound dressing,and 11 cases undertook operation again.Conclusion The causes of spinal tuberculosis retreatment include uncompleted debridement,drug resistant strains of tuberculosis,irregular postoperative anti-tubercular treatment,poor preoperative nutritional status and failure of spinal stability reconstruction.The key of successful revision surgery includes radical debridement,strut grafting with autologous iliac bone block,proper reconstruction of spinal stability,individualized chemotherapy according to the drug-resistance,and the appropriate use of irrigation and drainage postoperatively.