Management of Spine Tuberculosis With Chemotherapy and Percutaneous Pedicle Screws in Adjacent Vertebrae

Abstract

Retrospective study. The objective of this study was to evaluate the efficacy of local chemotherapy combined with percutaneous pedicle screw in adjacent vertebra in the treatment of spine tuberculosis (TB). Despite the increased treatment concepts and surgical methods, the management of TB, which is increasing in prevalence, remains challenging. Considerable complications existing in the conventional debridement surgery with TB spondylitis requires more attention. A retrospective evaluation containing 34 cases of spinal TB (17 males, 17 females; average age 59 years; 14 thoracic TB, 11 thoracolumbar TB, nine lumbar TB) between April 2007 and August 2014 was conducted. All patients were treated with local chemotherapy combined with percutaneous pedicle screw in adjacent vertebrae. The ASIA grade, the Cobb angle, and complications were investigated. All the patients were followed with an average of 18 (range, 12-52) months and were successfully treated without radiculopathy or neurological complications, with 27 excellent and seven fair outcomes at the final follow-up. One case that developed serious abscess in the primary focus underwent anterior focus debridement and bone graft fusion and recovered to the grade of fine at the final following up. As for kyphotic deformity, there was no Cobb angle loss. No other obvious complications were observed in all the patients. Local chemotherapy combined with percutaneous pedicle screw in adjacent vertebrae seems an effective method to treat spine TB, with some advantages including smaller trauma, fine neurologic recovery, few complications, and no Cobb angle loss. 3.