Results of surgical treatment in patients with tuberculous osteitis and progressing spondylitis

Abstract

Background Surgical treatment is essential for patients with tuberculous spondylitis, abscess and compression of the spinal cord. Conservative treatment is practical for patients with tuberculous osteitis uncomplicated with compression of the spinal cord. Objective Make a comparative analysis of surgical treatment produced for pre-spondylitis and post-spondylitis patients with spine tuberculosis. Material and methods Surgical treatment was performed for 17 (28.8 %) patients with tuberculous osteitis and 42 (71.2 %) patients with progressing spondylitis. Debriding resection of tuberculous focus, decompression of the spinal cord, abscess drainage were followed by anterior spine fusion with mesh cages or porous constructs of memory metal nitinol, posterior spondylodesis with self-locking shape memory clamps or transpedicular system. Results Static and dynamic spine function, ability to work were restored in 16 (94.8 %) patients with tuberculous osteitis and 29 (69.1 %) patients with progressing spondylitis. Complications developed in 30.9 % of the patients with progressing spondylitis. Conclusions Application of combined spondylodesis allowed for restoration of static and dynamic function of the spine in 17 cases at 6-month follow-up. Early ambulation of patients with tuberculous osteitis and spondylitis was shown to provide regression of neurological deficit after stabilization of anterior and posterior supporting vertebral column. Surgical treatment combined with chemical therapy at early stages of spine tuberculosis appeared to prevent infection and neurological complications, and considerably reduce rehabilitation period