The Reasons for Failure to Treat Thoracolumbar Tuberculosis by Anterior Internal Fixation and Its Countermeasures_West China Medical Journal

Authors：

 YANGJian ,  KANGJian-ping , WANGSong , LEIFei

Department of Spine Surgery, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan 646000, P. R. China;

Corresponding author：

KANGJian-ping, Email: kjp8@163.com

Keywords：

Spinal tuberculosis; Thoracolumbar tuberculosis; Internal fixation failure

DOI：

10.7507/1002-0179.20150007

Video：

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Objective To investigate the reasons for failure to treat thoracolumbar tuberculosis by anterior internal fixation and its countermeasures. Methods A total of 485 patients with thoracolumbar spinal tuberculosis underwent anterior focus clearance and fixation from January 2005 to January 2012. Eighteen of them failed with a rate of 3.71%. Screws were pulled out in two patients. Vertebra cutted by screws occurred in three patients. In another three patients, screws dropped into the intervertebral disc. Tuberculosis relapsed in 10 patients (5 accompanied with spinal deformity, 2 with pure malunion, 2 with abscess formation, and 1 with sequestra). Twelve of the patients underwent two-stage posterior pedicle screw internal fixation and anterior focus clearance and autogenous bone grafts fusion. Four were treated by shifting antituberculosis drugs and staying in bed. Two were cured by multiple abscesses puncture and antituberculosis injection. Results These patients were followed up for 15~30 months. Twelve cases of spinal tuberculosis were completely cured and 6 cases of them got clinical cure. However, 3 cases of them had scoliosis deformity followed and 1 had kyphosis. No tuberculosis relapse, cold abscess or sinus formation, or pedicle screw internal fixation failure occurred again. Conclusion Although there are many complications of anterior internal fixation for spinal tuberculosis, anterior internal fixation is still a perfect choice if we can make an appropriate choice of operation and strengthen the management after operation.

Citation： YANGJian, KANGJian-ping, WANGSong, LEIFei. The Reasons for Failure to Treat Thoracolumbar Tuberculosis by Anterior Internal Fixation and Its Countermeasures. West China Medical Journal, 2015, 30(1): 30-34. doi: 10.7507/1002-0179.20150007 Copy

1.	郭立新, 马远征, 陈兴, 等.脊柱结核的外科治疗与术后疗效评估[J].中华骨科杂志, 2008, 28(12):979-982.
2.	Hodgson AR, Stock FE. Anterior spine fusion for treatment of tuberculosis of the spine[J]. J Bone Joint surg (AM), 1960, 42:295-310.
3.	叶伟, 李春海, 梁安靖, 等.脊柱结核一期手术治疗的并发症分析及对策[J].中国医师进修杂志, 2010, 33(17):18-20.
4.	Chen WJ, Chen CH, Shi CH, et al. Surgical treatment of tuberculous spondylitis:50 patients followed for 2-8 years[J]. Acta Orthop Scand, 1995, 66(2):137-142.
5.	吴启秋.脊柱结核的化学治疗[J].中国脊柱脊髓杂志, 2004, 14(12):766-768.
6.	Bakhsh A. Medical management of spinal tuberculosis an experience from Pakistan[J]. Spine (Phila Pa 1976), 2010, 35(16):E787-E791.
7.	Konstam PG, Blesovsky A. The ambulant treatment of spinal tuberculosis[J]. Neurosurg Rev, 2001, 24(2):8-13.
8.	施建党, 王自立, 耿广起, 等.单纯应用抗结核药物治疗早期脊柱结核的疗效观察[J].中国脊柱脊髓杂志, 2011, 21(10):798-801.
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10.	Valsalan R, Purushothaman R, Raveendran M, et al. Efficacy of directly observed treatment short-course intermittent regimen in spinal tuberculosis[J]. Indian J Othop, 2012, 46(2):138-144.
11.	Rajasekaran S, Khandelwal G. Drug therapy in spinal tuberculosis[J]. Eur Spine J, 2013, 22(4):587-593.
12.	瞿东滨, 金大地.正确认识脊柱结核病灶清除术[J].中国脊柱脊髓杂志, 2008, 18(8):565-567.
13.	王自立.脊柱结核的病灶清除与融合固定问题[J].中国脊柱脊髓杂志, 2006, 16(12):888-889.
14.	林羽.浅谈脊柱结核的手术治疗[J].中国脊柱脊髓杂志, 2006, 16(12):885-887.
15.	戈朝晖, 王自立, 魏敏吉.脊柱结核病灶中抗痨药物浓度的测定[J].中华骨科杂志, 2005, 25(2):97-101.
16.	Parthasarathy R, Sriram K, Santha T, et al. Short-course chemotherapy for tuberculosis of the spine[J]. J Bone Joint Surg Br, 1999, 81(3):464-471.
17.	王自立, 杨伟宇, 金卫东, 等.病变椎体部分切除、髂骨植骨及内固定术治疗脊柱结核[J].中国脊柱脊髓杂志, 2004, 14(12):716-719, 723.
18.	林羽.科学务实, 进一步提高我国脊柱结核诊疗水平[J].中国脊柱脊髓杂志, 2004, 14(12):709-711.
19.	Zhang HQ, Wang YX, Guo CF, et al. One-stage posterior approach and combined interbody and posterior fusion for thoracolumbar spinal tuberculosis with kyphosis in children[J]. Orthopedics, 2010, 33(11):808.
20.	Christodoulou AG, Givissis P, Karataglis D, et al. Treatment of tuberculous spondylitis with anterior stabilization and titanium cage[J]. Clin Orthop Relat Res, 2006, 44(444):60-65.
21.	Ha KY, Chung YG, Ryoo SJ. Adherence and biofilm formation of Staphylococcus epidermidis and Mycobacterium tuberculosis on various spinal implants[J]. Spine (Phila Pa 1976), 2005, 30(1):38-43.
22.	Jain AK, Jain S. Instrumented stabilization in spinal tuberculosis[J]. Int Orthop, 2012, 36(2):285-292.
23.	Jain AK, Dhammi IK, Jain S, et al. Kyphosis in spinal tuberculosis:prevention and correction[J]. Indian J Orthop, 2010, 44(2):127-136.

1. 郭立新, 马远征, 陈兴, 等.脊柱结核的外科治疗与术后疗效评估[J].中华骨科杂志, 2008, 28(12):979-982.
2. Hodgson AR, Stock FE. Anterior spine fusion for treatment of tuberculosis of the spine[J]. J Bone Joint surg (AM), 1960, 42:295-310.
3. 叶伟, 李春海, 梁安靖, 等.脊柱结核一期手术治疗的并发症分析及对策[J].中国医师进修杂志, 2010, 33(17):18-20.
4. Chen WJ, Chen CH, Shi CH, et al. Surgical treatment of tuberculous spondylitis:50 patients followed for 2-8 years[J]. Acta Orthop Scand, 1995, 66(2):137-142.
5. 吴启秋.脊柱结核的化学治疗[J].中国脊柱脊髓杂志, 2004, 14(12):766-768.
6. Bakhsh A. Medical management of spinal tuberculosis an experience from Pakistan[J]. Spine (Phila Pa 1976), 2010, 35(16):E787-E791.
7. Konstam PG, Blesovsky A. The ambulant treatment of spinal tuberculosis[J]. Neurosurg Rev, 2001, 24(2):8-13.
8. 施建党, 王自立, 耿广起, 等.单纯应用抗结核药物治疗早期脊柱结核的疗效观察[J].中国脊柱脊髓杂志, 2011, 21(10):798-801.
9. Rafailidis PI, Avramopoulos I, Sapkas G, et al. Multidrug-resistant tuberculous spondylodiscitis:need for aggressive management and drug susceptibility testing of Mycobacterium tuberculosis isolates[J]. J Infect, 2006, 52(2):e35-e37.
10. Valsalan R, Purushothaman R, Raveendran M, et al. Efficacy of directly observed treatment short-course intermittent regimen in spinal tuberculosis[J]. Indian J Othop, 2012, 46(2):138-144.
11. Rajasekaran S, Khandelwal G. Drug therapy in spinal tuberculosis[J]. Eur Spine J, 2013, 22(4):587-593.
12. 瞿东滨, 金大地.正确认识脊柱结核病灶清除术[J].中国脊柱脊髓杂志, 2008, 18(8):565-567.
13. 王自立.脊柱结核的病灶清除与融合固定问题[J].中国脊柱脊髓杂志, 2006, 16(12):888-889.
14. 林羽.浅谈脊柱结核的手术治疗[J].中国脊柱脊髓杂志, 2006, 16(12):885-887.
15. 戈朝晖, 王自立, 魏敏吉.脊柱结核病灶中抗痨药物浓度的测定[J].中华骨科杂志, 2005, 25(2):97-101.
16. Parthasarathy R, Sriram K, Santha T, et al. Short-course chemotherapy for tuberculosis of the spine[J]. J Bone Joint Surg Br, 1999, 81(3):464-471.
17. 王自立, 杨伟宇, 金卫东, 等.病变椎体部分切除、髂骨植骨及内固定术治疗脊柱结核[J].中国脊柱脊髓杂志, 2004, 14(12):716-719, 723.
18. 林羽.科学务实, 进一步提高我国脊柱结核诊疗水平[J].中国脊柱脊髓杂志, 2004, 14(12):709-711.
19. Zhang HQ, Wang YX, Guo CF, et al. One-stage posterior approach and combined interbody and posterior fusion for thoracolumbar spinal tuberculosis with kyphosis in children[J]. Orthopedics, 2010, 33(11):808.
20. Christodoulou AG, Givissis P, Karataglis D, et al. Treatment of tuberculous spondylitis with anterior stabilization and titanium cage[J]. Clin Orthop Relat Res, 2006, 44(444):60-65.
21. Ha KY, Chung YG, Ryoo SJ. Adherence and biofilm formation of Staphylococcus epidermidis and Mycobacterium tuberculosis on various spinal implants[J]. Spine (Phila Pa 1976), 2005, 30(1):38-43.
22. Jain AK, Jain S. Instrumented stabilization in spinal tuberculosis[J]. Int Orthop, 2012, 36(2):285-292.
23. Jain AK, Dhammi IK, Jain S, et al. Kyphosis in spinal tuberculosis:prevention and correction[J]. Indian J Orthop, 2010, 44(2):127-136.

West China Medical Journal

The Reasons for Failure to Treat Thoracolumbar Tuberculosis by Anterior Internal Fixation and Its Countermeasures

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