Abstract:

Objective: To explore the application value of preoperative short-term chemotherapy in the rapid recovery of patients taking single-segment spinal tuberculosis anterior surgery. Methods: Fifty-six patients with spinal tuberculosis treated in the Department of Orthopedics of Hebei Chest Hospital from June 2017 to May 2019 were selected, including 28 males and 28 females, aged from 21 to 85 years. The diseased segment: there were 2 cases of cervical spine, 21 cases of thoracic spine, 28 cases of lumbar spine, and 5 cases of lumbosacral spine. All patients were given short-course chemotherapy before surgery, and H-R-Z-E quadruple anti-tuberculosis drugs were given routinely lasting 1-10 days, with an average of (6.90±1.35) days. The symptoms of systemic poisoning were improved, and the general condition of the whole body could tolerate the operation. After surgery, dynamic observations of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) changes, pain relief, nerve recovery, bone fusion, spinal tuberculosis cure rate, and complications were made. Results: Of the 56 patients enrolled, 1 case did not get early wound healing, but was healed after routine dressing change; 1 case got sinus formed, and the wound healed after sinus curettage. The remaining 54 cases all had wounds healed at first stage with level A healing. ESR ((20.96±7.97)mm/1h) at the 3rd week after operation were significantly lower than that before operation ((40.74±14.35) mm/1h), and the difference was statistically significant (t=23.198, P=0.000); CRP at the 3rd week after operation ((27.57±8.98) mg/L) was significantly lower than that before operation ((45.83±9.57)mg/L), and the difference was statistically significant (t=8.807, P=0.000); visual analogue scale (VAS) scores (3 (2,4)) at the 3rd week after operation was decreased significantly compared with the score before operation (6 (6,8)), and the difference was statistically significant (Z=-6.543,P=0.000). There were 29 patients with neurological impairment. At the end of follow-up, 2 patients with grade B impairment improved to grade D and 1 improved to grade E; within 10 patients with grade C impairment, 8 cases improved to grade E, and the others improved to grade D; all 17 patients with grade D impairment got improved to grade E. The positive rate of tuberculosis bacteria culture with samples collected from tuberculosis lesions during the operation was 44.6%(25/56), of which 1.8% (1/56) were single-drug-resistant, 3.6% (2/56) were multi-drug-resistant, and 1.8% (1/56) were poly-drug-resistant. 4-11 months after operation, 91.1% (51/56) of the 56 patients with intervertebral bone grafts achieved grade Ⅰ fusion, and 8.9% (5/56) of which achieved grade Ⅱ fusion according to Bridwell standards. Conclusion: For spine tuberculosis with indications, it is feasible to take a short course of preoperative chemotherapy before anterior debridement, bone graft fusion and internal fixation.

Key words: Tuberculosis,spinal, Premedication, Surgical procedures, Treatment outcome