Objective: To explore the differences between conservative and surgical treatment for thoracic and lumbar spine tuberculosis on indications and clinical results.
Methods: From May 2000 to June 2008, 162 cases of thoracic spinal tuberculosis patients were studied retrospectively, including 89 males and 73 females, aged from 4 to 71 years (means 43.6 years). Among them, 38 cases of onset time was short, X-ray showed a narrow cone gap and MRI showed vertebral body signal changes, the ones who had better general condition were applicated of anti-TB drugs [6HREZ (S)/6-9HRE] and traditional Chinese medicine dialectical; 51 cases with thick swollen and vertebral body marginal damage but not affect the stability of spine, were treated with spinal tuberculosis debridement surgery; 73 cases with abscess, vertebral destruction of center, spinal instability or spinal cord function associated with damage to persons, were treated with surgical debridement and interbody bone grafting and fixation. Clinical observation were evaluated according to the standard cure for bone tuberculosis.
Results: Thirty-eight cases by conservative treatment, had been cured in 1 to 2 years. Focus of infection cleared in 51 cases, 3 cases occurrenced the sinus next to incision, 4 cases of kyphosis angle (Cobb) lost 5 degrees-10 degrees compared with that before treatment (means 4.5 degrees). Seventy-three cases by internal fixation obtained neurological deficiency symptoms recovery; 2 occurenced the sinus next to the incision, 3 cases appeared subcutaneous emphysema of iliac area and local pain, but need no special treatment. A total of 136 patients were followed-up from 12 to 60 months with an average of 32.8 months, and had been all clinically cured.
Conclusion: Patients with early detection only on the imaging showing vertebral lesions, without obvious sequestrum, abscesses, can be selected for conservative anti-tuberculosis treatment. Patients combined with abscess, vertebral destruction on light degree and not affected the stability of the spine, can be removed by simple surgery to obtain better efficacy. Patients with abscesses, sequestrum, spinal vertebral instability leading to heavy damage associated with spinal cord or nerve function impairment,will need surgical removal of lesions of tuberculosis, give graft and spinal fixation at the same time.