Abstract: Objective  To investigate the clinical outcomes of the management with combination of surgery and individualized chemotherapy for the multi-drug resistant tuberculosis spondylitis. Methods  From February 2006 to June 2010, we retrospectively analyzed 21 cases of multi-drug resistant tuberculosis spondylitis admitted in the General Hospital of the General Staff Department of PLA. Among them, 6 were initial treatment cases, and 15 were retreatment cases. After admission, 21 patients received open operation or CT guided percutaneous drainage according to characteristics of the focus. Individualized chemotherapy regimens were tailored for each patient according to the drug resistance spectrum and previous history of anti-tuberculosis treatment after surgery and drug susceptibility testing. All patients were followed up clinically and radiologically for at least 18 months.  Results  Retreatment cases had undergone previous chemotherapy for an average of（19.30±15.80）(7-49) months. 19 cases received open operation and the other 2 received CT guided percutaneous drainage. Instrumentation failure was observed in one case and local recurrence was observed in 4 patients. Patients received individualized chemotherapy with an average of 18.3(18-20) months postoperatively. At the final follow-up, all of the 11 patients with paraplegia had a slight or remarkable recovery, and 9 patients with kyphosis had significant correction. 18 patients had treatment cure and the other 3 cases were still undergoing chemotherapy.  Conclusion  Management with combination of surgery and individualized chemotherapy is feasible in the treatment of severe complications and prevention dissemination of multi-drug resistant strains and development of acquired drug resistant spinal tuberculosis.

Key words: Tuberculosis,spinal/therapy, Orthopedic procedures, Drug therapy, Drug resistance, multiple, Clinical protocols, Microbial sensitivity tests