Abstract:

Objective To investigate the effect of perioperative osteoporosis treatment on enhanced recovery after surgery (ERAS) among elderly patients with lumbar tuberculosis. Methods Retrospective analysis was performed on 92 elderly patients (age ≥60 years) with lumbar tuberculosis who received surgical treatment in Beijing Chest Hospital of Capital Medical University from February 2017 to January 2020. All patients enrolled in the study had comorbidity of lumbar osteoporosis, and all patients received ERAS mode management. The patients were divided into the experimental group (48 cases) receiving anti-osteoporosis treatment and the control group (44 cases) not receiving anti-osteoporosis treatment. The effects of perioperative osteoporosis treatment on ERAS among elderly patients with lumbar tuberculosis were determined by comparing the differences of operative time, intraoperative blood loss, postoperative VAS score changes, postoperative bed time, postoperative bone graft fusion time, postoperative pedicle screw loosening, and postoperative complication rate. Results Lumbar tuberculosis was cured in all enrolled patients. After anti-osteoporosis treatment, postoperative bed rest time ((3.17±0.83) weeks), postoperative bone graft fusion time ((3.73±1.73) months) and postoperative incidence of pedicle screw loosening (6.2%, 3/48) in the experiemental group were lower than those ((3.91±0.86) weeks, (4.39±1.37) months, 15.9% (7/44)) in the control group, the differences were statistically significant (t=-4.208, P<0.001; t=-2.333, P=0.022; χ ²=4.310, P=0.038). There were no significant differences in operative time ((182.71±52.16) min, (173.75±37.83) min), intraoperative blood loss ((365.83±109.21) ml, (409.32±127.34) ml), postoperative VAS score improvement (5.29±1.24, 5.07±1.06) and postoperative complication rate (27.1% (13/48), 25.0% (11/44)) between the two groups (t=0.936, P=0.352; t=-1.762, P=0.088; t=1.033, P=0.304; χ ²=0.231, P=0.631). Conclusion Perioperative anti-osteoporosis therapy is an important part of ERAS measures for elderly lumbar tuberculosis patients complicated with osteoporosis, which can shorten postoperative bed time, maintain pedicle screw position, and accelerate bone graft fusion.

Key words: Tuberculosis, spinal, Lumbar vertebrae, Osteoporosis, Rehabilitation