Surgical treatment of spinal tuberculosis with spinal cord injury

PAN Han-sheng; YUAN Zhen-chao; LIU Ru-zhuan; BAO Jie; TANG Xiao-ju; LIU Rui; QI Wen

doi:10.3969/j.issn.2095-252X.2013.09.009

Abstract：Objective To investigate the clinical results of one-stage radical debridement, bone graft and internal fixation for spinal tuberculosis combined with nerve injuries on the basis of chemotherapy. Methods 42 patients with spinal tuberculosis combined with nerve injuries were adopted from April 2003 to April 2011, whose data were retrospectively analyzed. According to the damage classiifcation of neurological severity scores of American Spinal Injury Association ( ASIA ), there were 14 cases of grade B, 19 cases of grade C and 9 cases of grade D. Based on the standard chemotherapy and the severity of nerve injuries, 24 patients underwent the operation after receiving chemotherapy for 3 to 4 weeks. And while, 18 patients underwent the operation after receiving chemotherapy less than 2 weeks due to the progressively aggravated spinal cord injuries or increased abscess. One-stage radical debridement, bone graft and internal fixation were performed, with quadruple anti-tuberculosis treatment strictly strengthened postoperatively. And 3 months later, the triple chemotherapy was performed for 9 to 15 months. The improvement of neurological dysfunction was evaluated according to the ASIA neurological function evaluation, and the recovery of neurological function, lesions healing and internal fixation were analyzed. Results All patients were followed up for an average period of 24 months ( range;18-40 months ). Through the examinations of X-ray, CT or MRI, no residual lesions were found and no notable follow-up data were lost, with satisfactory correction of the kyphotic angle. According to the ASIA neurological function evaluation, signiifcant improvement was achieved in all patients in the latest follow-up. The preoperative sensory score was ( 90.93±35.59 ) and motor score was ( 51.04±11.86 ), and while the sensory score and motor score were ( 185.58±30.41 ) and ( 85.21±11.48 ) in the latest follow-up. Statistically signiifcant differences existed between them ( P<0.01 ). All lesions were healed with bony union, and no recurrence of tuberculosis was found. No related complications occurred, such as broken nails, broken rods, internal ifxation loosening, sinus formation and so on. Conclusions Most spinal tuberculosis combined with nerve compression occurs slowly. If the duration of symptoms becomes longer, the paralysis will be more severe and the prognosis will be worse. The operation should be performed as soon as possible based on the standard chemotherapy, including one-stage radical debridement, bone graft and internal ifxation, and satisfactory results will be achieved.