Experience in treating patients with spinaltuberculosis
Abstract
There is no consensus of opinion regarding the advisability of surgical treatment in patients with primary tuberculousosteitis due to the high risk of postoperative complications. Purpose: to analyze of the results of multimodal chemotherapeutic and surgical treatment of patients in stages I-IV of the spinal tuberculosis process. Material and methods. Surgical treatment was carried out in 12 (27,9%) patients with tuberculousosteitis (Stage I), in 4 (9,3%) patients with progressive Stage II spondyloarthritis and in 27 (62,8%) patients in Stages III and IV of the tuberculous process. Anterior spondylodesis was performed in 5 (41,7%) of 12 patients with osteitis, posterior spondylodesis in 2 (4,7%) patients with progressive Stage III spondyloarthritis of vertebrae С1-С2. Combined spondylodesis was performed in 36 (83,7%) of 43 patients with spinal tuberculosis in Stages from I to IV complicated by spinal cord compression and abscess formation. Results. The musculoskeletal function of the spine in 15 (93,7%) of 16 patients with spinal tuberculosis operated in Stages I and II of the process was completely recovered after 4 months and in 23 (85,2%) of 27 patients with tuberculous process in Stages III and IV after 10 to 11 months. Complications of purulent and inflammatory nature in the immediate postoperative period were in 4 (22,2%) of 18 patients with tuberculous process of Stages III and IV, complicated by abscess formation. Conclusions: The surgical treatment in conjunction with chemotherapy, undertaken in the Stages I and II of the spinal tuberculosis, allows the complete recovery of the musculoskeletal function of the spine in 93,7% of cases. Correction of kyphotic deformation in patients with chronic destructive spondyloarthritis with damage of more than two vertebral motion segments in Stage IV is possible within 15о. The periods of the rehabilitation time in patients operated in Stage IV of the tuberculosis process, complicated by abscess formation, are twice as long as the periods of treatment of patients operated in Stages I and II of the spinal tuberculosis. The number of purulent and inflammatory complications in the early postoperative period in patients with spinal tuberculosis in Stages III and IV with abscess formation reaches 22,2%.
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