Skip to main content
Top
Published in: European Spine Journal 12/2016

01-12-2016 | Original Article

Is duration of preoperative anti-tuberculosis treatment a risk factor for postoperative relapse or non-healing of spinal tuberculosis?

Authors: Hai-long Ren, Jian-ming Jiang, Ji-xing Wang, Dong-bin Qu, Jian-ting Chen

Published in: European Spine Journal | Issue 12/2016

Login to get access

Abstract

Purpose

This study evaluated the relationship between spinal TB postoperative recurrence or non-healing and duration of preoperative anti-TB treatment (ATT).

Methods

From January 2004 to January 2013, patients who underwent surgery for spinal TB and met this study’s inclusion criteria were retrospectively reviewed. Observed parameters were age, sex, initial ESR, preoperative ESR, degree of ESR change, initial CRP, preoperative CRP, degree of CRP change, duration of preoperative ATT, surgical approach, presence of internal fixation, location of spinal lesion, number of involved segments, duration of operation, and intraoperative blood loss. The data were analyzed by univariate and multivariate analyses for spinal TB recurrence or non-healing to determine related risk factors.

Results

A total of 223 patients met the inclusion criteria. There were 84 female and 139 male patients with a mean age of 42.2 years (range 2–85 years). The follow-up period was 18–72 months (average 28.7 months). Among 223 patients observed, 23 patients had postoperative relapse or non-healing (10.3 %) during the follow-up period. Statistical analysis indicated that the location of a spinal lesion was significantly associated with postoperative relapse or non-healing. Risk of postoperative relapse or non-healing in thoracolumbar TB was 2.524-fold (95 % CI 1.026–6.580) that of lumbosacral TB.

Conclusions

Duration of preoperative ATT may not be a risk factor for postoperative recurrence or non-healing of spinal TB. Junctional zones such as the lumbosacral and thoracolumbar junction have a higher recurrence rate than non junctional.
Literature
1.
go back to reference Turgut M (2001) Spinal tuberculosis (Pott’s disease): its clinical presentation, surgical management and outcome. A survey study on 694 patients. Neurosurg Rev 24:8–13CrossRefPubMed Turgut M (2001) Spinal tuberculosis (Pott’s disease): its clinical presentation, surgical management and outcome. A survey study on 694 patients. Neurosurg Rev 24:8–13CrossRefPubMed
2.
go back to reference Zhang HQ, Lin MZ, Guo HB et al (2013) One-stage surgical management for tuberculosis of the upper cervical spine by posterior debridement, short-segment fusion, and posterior instrumentation in children. Eur Spine J 22:72–78CrossRefPubMed Zhang HQ, Lin MZ, Guo HB et al (2013) One-stage surgical management for tuberculosis of the upper cervical spine by posterior debridement, short-segment fusion, and posterior instrumentation in children. Eur Spine J 22:72–78CrossRefPubMed
3.
go back to reference Shi JD, Wang ZL, Geng GQ et al (2012) Intervertebral focal surgery for the treatment of non-contiguous multifocal spinal tuberculosis. Int Orthop 36:1423–1427CrossRefPubMedPubMedCentral Shi JD, Wang ZL, Geng GQ et al (2012) Intervertebral focal surgery for the treatment of non-contiguous multifocal spinal tuberculosis. Int Orthop 36:1423–1427CrossRefPubMedPubMedCentral
4.
go back to reference Wang X, Pang X, Wu P et al (2014) One-stage anterior debridement, bone grafting and posterior instrumentation vs. single posterior debridement, bone grafting, and instrumentation for the treatment of thoracic and lumbar spinal tuberculosis. Eur Spine J 23:830–837CrossRefPubMed Wang X, Pang X, Wu P et al (2014) One-stage anterior debridement, bone grafting and posterior instrumentation vs. single posterior debridement, bone grafting, and instrumentation for the treatment of thoracic and lumbar spinal tuberculosis. Eur Spine J 23:830–837CrossRefPubMed
6.
go back to reference Alici E, Akcali O, Tatari H et al (2001) Effect of preoperative chemotherapy on the outcome of surgical treatment of vertebral tuberculosis: retrospective analysis of 434 cases. Arch Orthop Trauma Surg 121:65–66CrossRefPubMed Alici E, Akcali O, Tatari H et al (2001) Effect of preoperative chemotherapy on the outcome of surgical treatment of vertebral tuberculosis: retrospective analysis of 434 cases. Arch Orthop Trauma Surg 121:65–66CrossRefPubMed
7.
go back to reference Pu X, Zhou Q, He Q et al (2012) A posterior versus anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberculosis. Int Orthop 36:307–313CrossRefPubMed Pu X, Zhou Q, He Q et al (2012) A posterior versus anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberculosis. Int Orthop 36:307–313CrossRefPubMed
8.
go back to reference Pang X, Shen X, Wu P et al (2013) Thoracolumbar spinal tuberculosis with psoas abscesses treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage. Arch Orthop Trauma Surg 133:765–772CrossRefPubMed Pang X, Shen X, Wu P et al (2013) Thoracolumbar spinal tuberculosis with psoas abscesses treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage. Arch Orthop Trauma Surg 133:765–772CrossRefPubMed
9.
go back to reference Wang Z, Wu Q, Geng G (2013) Anterior debridement and bone grafting with posterior single-segment internal fixation for the treatment of mono-segmental spinal tuberculosis. Injury 44:253–257CrossRefPubMed Wang Z, Wu Q, Geng G (2013) Anterior debridement and bone grafting with posterior single-segment internal fixation for the treatment of mono-segmental spinal tuberculosis. Injury 44:253–257CrossRefPubMed
10.
go back to reference Ling T, Liu L, Yang X et al (2015) Revision surgery for spinal tuberculosis with secondary deformity after treatment with debridement, instrumentation, and fusion. Eur Spine J 24:577–585CrossRefPubMed Ling T, Liu L, Yang X et al (2015) Revision surgery for spinal tuberculosis with secondary deformity after treatment with debridement, instrumentation, and fusion. Eur Spine J 24:577–585CrossRefPubMed
11.
go back to reference Huang QS, Zheng C, Hu Y et al (2009) One-stage surgical management for children with spinal tuberculosis by anterior decompression and posterior instrumentation. Int Orthop 33:1385–1390CrossRefPubMedPubMedCentral Huang QS, Zheng C, Hu Y et al (2009) One-stage surgical management for children with spinal tuberculosis by anterior decompression and posterior instrumentation. Int Orthop 33:1385–1390CrossRefPubMedPubMedCentral
12.
go back to reference Zhao J, Lian XF, Hou TS et al (2007) Anterior debridement and bone grafting of spinal tuberculosis with one-stage instrumentation anteriorly or posteriorly. Int Orthop 31:859–863CrossRefPubMed Zhao J, Lian XF, Hou TS et al (2007) Anterior debridement and bone grafting of spinal tuberculosis with one-stage instrumentation anteriorly or posteriorly. Int Orthop 31:859–863CrossRefPubMed
13.
go back to reference Li M, Du J, Meng H et al (2011) One-stage surgical management for thoracic tuberculosis by anterior debridement, decompression and autogenous rib grafts, and instrumentation. Spine J 11:726–733CrossRefPubMed Li M, Du J, Meng H et al (2011) One-stage surgical management for thoracic tuberculosis by anterior debridement, decompression and autogenous rib grafts, and instrumentation. Spine J 11:726–733CrossRefPubMed
14.
go back to reference Dai LY, Jiang LS, Wang YR et al (2010) Chemotherapy in anterior instrumentation for spinal tuberculosis: highlighting a 9-month three-drug regimen. World Neurosurg 73:560–564CrossRefPubMed Dai LY, Jiang LS, Wang YR et al (2010) Chemotherapy in anterior instrumentation for spinal tuberculosis: highlighting a 9-month three-drug regimen. World Neurosurg 73:560–564CrossRefPubMed
15.
go back to reference Furák J, Troján I, Szöke T et al (2001) Surgical intervention for pulmonary tuberculosis: analysis of indications and perioperative data relating to diagnostic and therapeutic resections. Eur J Cardiothorac Surg 20:722–727CrossRefPubMed Furák J, Troján I, Szöke T et al (2001) Surgical intervention for pulmonary tuberculosis: analysis of indications and perioperative data relating to diagnostic and therapeutic resections. Eur J Cardiothorac Surg 20:722–727CrossRefPubMed
16.
go back to reference Vashakidze S, Gogishvili S, Nikolaishvili K et al (2013) Favorable outcomes for multidrug and extensively drug resistant tuberculosis patients undergoing surgery. Ann Thorac Surg 95:1892–1898CrossRefPubMedPubMedCentral Vashakidze S, Gogishvili S, Nikolaishvili K et al (2013) Favorable outcomes for multidrug and extensively drug resistant tuberculosis patients undergoing surgery. Ann Thorac Surg 95:1892–1898CrossRefPubMedPubMedCentral
17.
go back to reference Cavuşoğlu H, Kaya RA, Türkmenoğlu ON et al (2008) A long-term follow-up study of anterior tibial allografting and instrumentation in the management of thoracolumbar tuberculous spondylitis. J Neurosurg Spine 8:30–38CrossRefPubMed Cavuşoğlu H, Kaya RA, Türkmenoğlu ON et al (2008) A long-term follow-up study of anterior tibial allografting and instrumentation in the management of thoracolumbar tuberculous spondylitis. J Neurosurg Spine 8:30–38CrossRefPubMed
18.
go back to reference Güzey FK, Emel E, Bas NS et al (2005) Thoracic and lumbar tuberculous spondylitis treated by posterior debridement, graft placement, and instrumentation: a retrospective analysis in 19 cases. J Neurosurg Spine 3:450–458CrossRefPubMed Güzey FK, Emel E, Bas NS et al (2005) Thoracic and lumbar tuberculous spondylitis treated by posterior debridement, graft placement, and instrumentation: a retrospective analysis in 19 cases. J Neurosurg Spine 3:450–458CrossRefPubMed
19.
go back to reference Ge Z, Wang Z, Wei M (2008) Measurement of the concentration of three antituberculosis drugs in the focus of spinal tuberculosis. Eur Spine J 17:1482–1487CrossRefPubMedPubMedCentral Ge Z, Wang Z, Wei M (2008) Measurement of the concentration of three antituberculosis drugs in the focus of spinal tuberculosis. Eur Spine J 17:1482–1487CrossRefPubMedPubMedCentral
20.
go back to reference Sai Kiran NA, Vaishya S, Kale SS et al (2007) Surgical results in patients with tuberculosis of the spine and severe lower-extremity motor deficits: a retrospective study of 48 patients. J Neurosurg Spine 6:320–326CrossRefPubMed Sai Kiran NA, Vaishya S, Kale SS et al (2007) Surgical results in patients with tuberculosis of the spine and severe lower-extremity motor deficits: a retrospective study of 48 patients. J Neurosurg Spine 6:320–326CrossRefPubMed
21.
go back to reference Gao Z, Wang M, Zhu W et al (2015) Tuberculosis of ultralong segmental thoracic and lumbar vertebrae treated by posterior fixation and cleaning of the infection center through a cross-window. Spine J 15:71–78CrossRefPubMed Gao Z, Wang M, Zhu W et al (2015) Tuberculosis of ultralong segmental thoracic and lumbar vertebrae treated by posterior fixation and cleaning of the infection center through a cross-window. Spine J 15:71–78CrossRefPubMed
22.
go back to reference Cheng Z, Wang J, Zheng Q et al (2015) Anterolateral radical debridement and interbody bone grafting combined with transpedicle fixation in the treatment of thoracolumbar spinal tuberculosis. Medicine 94:e721CrossRefPubMedPubMedCentral Cheng Z, Wang J, Zheng Q et al (2015) Anterolateral radical debridement and interbody bone grafting combined with transpedicle fixation in the treatment of thoracolumbar spinal tuberculosis. Medicine 94:e721CrossRefPubMedPubMedCentral
23.
go back to reference Shi J, Tang X, Xu Y et al (2014) Single-stage internal fixation for thoracolumbar spinal tuberculosis using 4 different surgical approaches. J Spinal Disord Tech 27:E247–E257CrossRefPubMed Shi J, Tang X, Xu Y et al (2014) Single-stage internal fixation for thoracolumbar spinal tuberculosis using 4 different surgical approaches. J Spinal Disord Tech 27:E247–E257CrossRefPubMed
24.
go back to reference Zhang P, Shen Y, Ding WY et al (2014) The role of surgical timing in the treatment of thoracic and lumbar spinal tuberculosis. Arch Orthop Trauma Surg 134:167–172CrossRefPubMed Zhang P, Shen Y, Ding WY et al (2014) The role of surgical timing in the treatment of thoracic and lumbar spinal tuberculosis. Arch Orthop Trauma Surg 134:167–172CrossRefPubMed
25.
26.
go back to reference Oga M, Arizono T, Takasita M et al (1993) Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study. Spine (Phila Pa 1976) 18:1890–1894CrossRef Oga M, Arizono T, Takasita M et al (1993) Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study. Spine (Phila Pa 1976) 18:1890–1894CrossRef
27.
go back to reference Klöckner C, Valencia R (2003) Sagittal alignment after anterior debridement and fusion Witll or without additional posterior instrumentation in the treatment of pyogenic and tuberculous spondylodiseitis. Spine (Phila Pa 1976) 28:1036–1042 Klöckner C, Valencia R (2003) Sagittal alignment after anterior debridement and fusion Witll or without additional posterior instrumentation in the treatment of pyogenic and tuberculous spondylodiseitis. Spine (Phila Pa 1976) 28:1036–1042
28.
go back to reference Yilmaz C, Selek HY, Gürkan I et al (1999) Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Joint Surg Am 81:1261–1267CrossRefPubMed Yilmaz C, Selek HY, Gürkan I et al (1999) Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Joint Surg Am 81:1261–1267CrossRefPubMed
29.
go back to reference Ha KY, Chung YG, Ryoo SJ (2005) Adherence and biofilm formation of Staphylococcus epidermidis and Mycobacterium tuberculosis on various spinal implants. Spine (Phila Pa 1976) 30:38–43CrossRef Ha KY, Chung YG, Ryoo SJ (2005) Adherence and biofilm formation of Staphylococcus epidermidis and Mycobacterium tuberculosis on various spinal implants. Spine (Phila Pa 1976) 30:38–43CrossRef
30.
go back to reference Kohli SB (1967) Radical surgical approach to spinal tuberculosis. J Bone Joint Surg Br 49:668–673PubMed Kohli SB (1967) Radical surgical approach to spinal tuberculosis. J Bone Joint Surg Br 49:668–673PubMed
31.
go back to reference He M, Xu H, Zhao J et al (2014) Anterior debridement, decompression, bone grafting, and instrumentation for lower cervical spine tuberculosis. Spine J 14:619–627CrossRefPubMed He M, Xu H, Zhao J et al (2014) Anterior debridement, decompression, bone grafting, and instrumentation for lower cervical spine tuberculosis. Spine J 14:619–627CrossRefPubMed
32.
go back to reference Wang B, Lv G, Liu W et al (2011) Anterior radical debridement and reconstruction using titanium mesh cage for the surgical treatment of thoracic and thoracolumbar spinal tuberculosis: minimum five-year follow-up. Turk Neurosurg 21:575–581PubMed Wang B, Lv G, Liu W et al (2011) Anterior radical debridement and reconstruction using titanium mesh cage for the surgical treatment of thoracic and thoracolumbar spinal tuberculosis: minimum five-year follow-up. Turk Neurosurg 21:575–581PubMed
33.
go back to reference Song JF, Jing ZZ, Chen B et al (2012) One-stage anterolateral surgical treatment for lumbosacral segment tuberculosis. Int Orthop 36:339–344CrossRefPubMed Song JF, Jing ZZ, Chen B et al (2012) One-stage anterolateral surgical treatment for lumbosacral segment tuberculosis. Int Orthop 36:339–344CrossRefPubMed
34.
go back to reference Hu J, Li D, Kang Y et al (2014) Active thoracic and lumbar spinal tuberculosis in children with kyphotic deformity treated by one-stage posterior instrumentation combined anterior debridement. Eur J Orthop Surg Traumatol 24(Suppl 1):S221–S229CrossRefPubMed Hu J, Li D, Kang Y et al (2014) Active thoracic and lumbar spinal tuberculosis in children with kyphotic deformity treated by one-stage posterior instrumentation combined anterior debridement. Eur J Orthop Surg Traumatol 24(Suppl 1):S221–S229CrossRefPubMed
35.
go back to reference Liu Z, Liu J, Peng A et al (2014) One-stage posterior debridement and transpedicular screw fixation for treating monosegmental thoracic and lumbar spinal tuberculosis in adults. Sci World J. doi:10.1155/2014/137106 Liu Z, Liu J, Peng A et al (2014) One-stage posterior debridement and transpedicular screw fixation for treating monosegmental thoracic and lumbar spinal tuberculosis in adults. Sci World J. doi:10.​1155/​2014/​137106
36.
go back to reference Sahoo MM, Mahapatra SK, Sethi GC et al (2012) Posterior-only approach surgery for fixation and decompression of thoracolumbar spinal tuberculosis: a retrospective study. J Spinal Disord Tech 25:E217–E223CrossRefPubMed Sahoo MM, Mahapatra SK, Sethi GC et al (2012) Posterior-only approach surgery for fixation and decompression of thoracolumbar spinal tuberculosis: a retrospective study. J Spinal Disord Tech 25:E217–E223CrossRefPubMed
37.
go back to reference Liu P, Zhu Q, Jiang J (2011) Distribution of three antituberculous drugs and their metabolites in different parts of pathological vertebrae with spinal tuberculosis. Spine (Phila Pa 1976) 36:E1290–E1295CrossRef Liu P, Zhu Q, Jiang J (2011) Distribution of three antituberculous drugs and their metabolites in different parts of pathological vertebrae with spinal tuberculosis. Spine (Phila Pa 1976) 36:E1290–E1295CrossRef
38.
go back to reference Wang Z, Ge Z, Jin W et al (2007) Treatment of spinal tuberculosis with ultrashort—course chemotherapy in conjunction with partial excision of pathologic vertebrae. Spine J 7:671–681CrossRefPubMed Wang Z, Ge Z, Jin W et al (2007) Treatment of spinal tuberculosis with ultrashort—course chemotherapy in conjunction with partial excision of pathologic vertebrae. Spine J 7:671–681CrossRefPubMed
39.
go back to reference Moon MS (1997) Tuberculosis of the spine. Controversies and a new challenge. Spine (Phila Pa 1976) 22:1791–1797CrossRef Moon MS (1997) Tuberculosis of the spine. Controversies and a new challenge. Spine (Phila Pa 1976) 22:1791–1797CrossRef
Metadata
Title
Is duration of preoperative anti-tuberculosis treatment a risk factor for postoperative relapse or non-healing of spinal tuberculosis?
Authors
Hai-long Ren
Jian-ming Jiang
Ji-xing Wang
Dong-bin Qu
Jian-ting Chen
Publication date
01-12-2016
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 12/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-016-4496-2

Other articles of this Issue 12/2016

European Spine Journal 12/2016 Go to the issue