Abstract:

Objective To summarize the reasons and clinical treatments of postoperative recurrence of spinal tuberculosis in lumbosacral portion. Methods Eighty-four patients with spinal tuberculosis in lumbosacral portion admitted to the Department of Orthopedics, the Chest Hospital of Hebei Province from June 2013 to June 2016 were retrospectively studied, including 15 patients with postoperative recurrence of spinal tuberculosis as observation group and 69 patients without recurrence of spinal tuberculosis as control group. Risk factors for postoperative recurrence of spinal tuberculosis in lumbosacral portion were determined by univariate and multivariate logistic regression analysis. Individual operation was performed for the patients in the observation group. All patients were treated by anti-tuberculosis chemotherapy for 18-24 months. To evaluate the therapeutic effects, lesion healing and bone graft fusion were observed during follow-up period. Results The preoperative blood albumin level, bone graft fusion rate, postoperative standard anti-tuberculosis treatment rate and degree of debridement of the observation group were (35.56±6.04)g/L, 53.3% (8/15), 60.0% (9/15) and 46.7% (7/15), which were significantly lower than those of the control group ((38.71±5.25)g/L, 85.5% (59/69), 89.9% (62/69) and 87.0% (60/69)). The incidence of drug resistance and concurrent tuberculosis at other parts of the observation group were 33.3% (5/15) and 60.0% (9/15), which were significantly higher than those of the control group (11.6% (8/69) and 29.0% (20/69)). There were significant differences between the two groups (t=2.05, χ ²=7.90, χ ²=21.84, χ ²=12.39, χ ²=4.45, χ ²=5.24; P values were 0.043, 0.010, 0.000, 0.000, 0.035 and 0.022). Multivariate logistic regression analysis showed that albumin level <35g/L (OR=7.32, 95%CI: 1.04-51.28), without complete debridement (OR=25.17, 95%CI: 3.06-207.29), without graft bone fusion (OR=9.38, 95%CI: 1.13-77.90), postoperative irregular chemotherapy (OR=20.44, 95%CI: 1.23-339.25), drug resistance (OR=18.57, 95%CI: 1.61-213.77) and concurrent tuberculosis at other parts (OR=13.91, 95%CI: 1.64-117.87) were the risk factors for postoperative recurrence of spinal tuberculosis in lumbosacral portion. The follow-up period ranged from 28-62 months (average (36.5±11.2)months). All 15 cases were recovered by adjusting therapeutic scheme and reoperation, the bone graft was successfully fused, and there was no recurrence during the follow-up period. Conclusion The early and positive therapies such as nutritional support, standard and effective anti-tuberculosis chemotherapy according to hypersensitive test and reoperation based on imaging manifestation were the keys to improve the curative effect.

Key words: Tuberculosis, spinal, Lumbosacral region, Recurrence, Surgical procedures, operative, Factor analysis, statistical