关键词: 结核, 脊柱/药物疗法, 抗结核药

Abstract: Objective To evaluate the efficacy of conservative treatment in patients with tuberculosis (TB) of the spine, and to explore the indications for non-surgical treatment of the spinal TB. Methods  A prospectively study was conducted. Fifty-four patients with active TB of the spine who initially received non-surgical treatment in the Orthopaedic Department of the 309^th Hospital of Chinese People’s Liberation Army from January 2007 to January 2012 were recruited in the study. The diagnosis of TB was based on clinical presentation, findings on imaging, laboratory examinations and experimental anti-TB chemotherapy. The image-guided biopsies were also performed if needed. The patients received anti-TB combination drug chemotherapy for 9-18 months and the treatment durations were adapted individually according to the treatment outcomes during the follow-up, such as the clinical manifestation, progress of healing of the focus and change of spinal physiological curvature. The liver function, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were tested regularly. The image-guided percutaneous catheter drainage was performed in 6 patients who had huge abscess. The follow-up duration was 1.5-5.5 years, mean (3.0±0.8) years. Results Patient ages ranged 12-74 years (mean: (42.5±3.5) years). The duration of prodromal symptoms before admission ranged 2-8 months (mean: (4.5±1.2) months). The infection was localized to a single vertebra in 2 patients, localized to 2 contiguous vertebras in 28 patients, and localized to more than 3 vertebras in 24 patients. All patients presented with abscesses, had no neurological deficits or severe back pain, the kyphotic angles were smaller than 30°. Out of 54 patients, 49 patients were healed by conservative treatment with anti-TB drugs, and none of them had residual instability or neurological compromise. Among 49 patients, the local pain released in 45 patient while 4 patients only had mild back pain and no need to take analgesic drugs; bony fusion and fibrosis was observed on radiographic or CT films in 32 and 17 patients respectively, the average increase of kyphotic angle was (5.5±0.8)°. The levels of ESR and CRP decreased to the normal range in 47 patients. Eighteen patients were found to have drug side-effects during treatment, but they were manageable by stopping to take the related anti-TB drugs or by applying the corresponding pharmacological treatment. Five patients received operation due to severe back pain, neurological deficit or progressing kyphosis.  Conclusion Patients with TB of the spine, who have no severe back pain, neurological deficits or unacceptable sagittal alignment, can be well ma-naged through conservative treatment with anti-TB drugs.

Key words: Tuberculosis, spinal/drug therapy, Antitubercular agents