Peer-Review ReportTechniqueChemotherapy in Anterior Instrumentation for Spinal Tuberculosis: Highlighting a 9-Month Three-Drug Regimen
Introduction
As the most important achievement in the treatment of tuberculosis, chemotherapy has been the mainstay of management of spinal tuberculosis (20, 23, 29). Since surgical intervention was recommended for patients with unresponsiveness or noncompliance with antituberculous chemotherapy, anterior radical debridement with autologous grafting of the defect has been popularized in the treatment of spinal tuberculosis. In response to the success in surgical treatment of spinal tuberculosis, a variety of short-course chemotherapy regimens have been employed in combination with radical surgery (1, 5, 15, 17, 26, 30). However, there remains controversy on the duration of chemotherapy regardless of whether surgical intervention is warranted.
Recently, anterior instrumentation has been used following radical debridement and bone grafting in the single stage. The use of anterior instrumentation can effectively correct kyphotic deformity and provide stable alignment and solid fusion on the basis of proper decompression and bone grafting. It has been shown that this procedure is not associated with an increase in the perioperative complications and postoperative persistence or recurrence of spinal tuberculous infection; thus, it may eliminate the concern of placing the implant in the center of infection as a foreign body for bacterial attachment (2, 3, 6, 8, 10, 11, 13, 25, 33).
The purpose of the study was to determine the efficacy of an antituberculous chemotherapy regimen by following prospectively a series of patients with spinal tuberculosis for a minimum of 3 years who underwent single-stage anterior radical debridement, autogenous bone grafting, and instrumentation. The clinical and radiographic outcomes of these patients were analyzed with special reference to postoperative chemotherapy with a 9-month three-drug regimen.
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Materials and Methods
This study included 57 consecutive patients who were treated surgically with single-stage anterior radical debridement, autogenous bone grafting, and instrumentation at the authors' institution from 1999 to 2004. There were 33 men and 24 women with an average age of 52 years (range = 23-81 years) at the time of surgery. The indications for surgical intervention included severe cervical or back pain and/or radicular pain resistant to conservative treatment, neurologic deficits with associated
Results
All patients experienced immediate relief of their cervical or back pain on the first postoperative day. Twenty-two patients had mild pain at the final follow-up examination, but none of them needed analgesic drugs. Thirty-five patients with neurologic deficit as defined by Frankel scale as grade B to D on admission showed improvement in different degrees at the final follow-up visit. Thirty of them recovered completely to normal (Grade E). No one had neurologic deterioration. All five patients
Discussion
With regard to the efficacy of antituberculous chemotherapy regimens for spinal tuberculosis, there have been at least, to the best of our knowledge, two randomized controlled trials comparing chemotherapy alone with surgical debridement plus chemotherapy. In one study, all participants received para-aminosalicylic acid and isoniazid for 18 months with or without streptomycin for the first 3 months (16, 19), whereas a 6-month regimen of isoniazid and rifampicin was undertaken in the other study
References (33)
- et al.
Treatment of spinal tuberculosis with ultrashort-course chemotherapy in conjunction with partial excision of pathologic vertebrae
Spine J
(2007) - et al.
Effect of preoperative chemotherapy on the outcome of surgical treatment of vertebral tuberculosis: retrospective analysis of 434 cases
Arch Orthop Trauma Surg
(2001) - et al.
Anterior radical debridement and anterior instrumentation in tuberculosis spondylitis
Eur Spine J
(2003) - et al.
Comparison of anterior instrumentation systems and the results of minimum 5 years follow-up in the treatment of tuberculosis spondylitis
Kobe J Med Sci
(2004) - et al.
Anterior instrumentation in tuberculous spondylitis: is it effective and safe?
Clin Orthop Relat Res
(2007) - et al.
Tuberculous spondylitis of the lumbosacral region: long-term follow-up of patients treated by chemotherapy, transpedicular drainage, posterior instrumentation, and fusion
J Spinal Disord Tech
(2005) - et al.
Single-stage anterior autogenous bone grafting and instrumentation in the surgical management of spinal tuberculosis
Spine
(2005) - et al.
Measurement of the concentration of three antituberculosis drugs in the focus of spinal tuberculosis
Eur Spine J
(2008) The outcome of allografts and anterior instrumentation in spinal tuberculosis
Clin Orthop Relat Res
(2002)- et al.
Adherence and biofilm formation of Staphylococcus epidermidis and Mycobacterium tuberculosis on various spinal implants
Spine
(2005)
Anterior plating for lower cervical spine tuberculosis
Int Orthop
One-stage anterior interbody autografting and instrumentation in primary surgical management of thoracolumbar spinal tuberculosis
Eur Spine J
Penetration of isoniazid, rifampicin and pyrazinamide in tuberculous pleural effusion and psoas abscess
Int J Tuberc Lung Dis
Tuberculosis of the lumbar spine: outcomes after combined treatment of two-drug therapy and surgery
Orthopedics
The penetration of drugs into the lesions of spinal tuberculosis
Int Orthop
Single-stage transpedicular decompression and posterior instrumentation in treatment of thoracic and thoracolumbar spinal tuberculosis: a retrospective case series
J Spinal Disord Tech
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