Abstract
Recurrent complex spinal tuberculosis accompanied by sinus tract formation is one of the most common and complex types of recurrent tuberculosis. To date, only very few studies have reported the strategies and effectiveness of surgical treatments on postoperative recurrent spinal tuberculosis accompanied by sinus tract formation. In this study, 21 recurrent patients out of 87 patients with complex spinal tuberculosis were reviewed. The data of the patients, including age, gender, existence of drug-resistant mycobacterium tuberculosis, postoperative standard chemotherapy, completeness of lesion debridement, reconstruction of the spinal stability, nutritional status, accompaniment by tuberculosis in other regions, timing of the operations, and areas of the lesions, were collected for single- and multiple-factor analyses. The clinical outcomes were evaluated by long-term follow-ups. The results showed that 7 factors were significantly associated with postoperative recurrence of complex spinal tuberculosis accompanied by sinus tract formation. This suggested that when we treat complex spinal tuberculosis, we should pay more attention to these seven indicators to avoid postoperative recurrence, and our clinical outcomes suggested that it is difficult to treat recurrent complicated spinal tuberculosis combined with sinus tract formation. The key for successful surgical treatment includes effective chemotherapy, radical debridement and proper reconstruction of spinal stability.
Highlights
300 years ago, Percival Pott reported the first modern case of spinal tuberculosis in 17791
The single-factor analysis showed that 7 factors, including the existence of drug-resistant mycobacterium tuberculosis, standard postoperative chemotherapy, completeness of the lesion debridement, reconstruction of spinal stability, nutritional status, accompaniment by tuberculosis in other regions, and the timing of the operation, were significantly associated with postoperative recurrence of complex spinal tuberculosis accompanied by sinus tract formation (P < 0.05), while the other factors were not significantly associated with recurrence (Table 3)
The multi-factor analysis showed that these 7 factors were significantly associated with postoperative recurrence of complex spinal tuberculosis accompanied by sinus tract formation (P < 0.05) (Table 4)
Summary
300 years ago, Percival Pott reported the first modern case of spinal tuberculosis in 17791. Improvement in the systemic and local symptoms, enlargement of abscesses, unhealed incisions, and sinus tract formation, all of which severely affect the life quality of the patients. Among these symptoms, the combination with sinus tract formation is one of the most common and complex ones. Studies have mainly investigated the clinical effectiveness on spinal tuberculosis accompanied by sinus tract formation before initial surgical treatments. Only a few studies have reported the strategy of surgical treatments and their effectiveness on postoperatively recurrent spinal tuberculosis accompanied by sinus tract formation. The aims of this study were as follows: (1) to summarize the reasons for postoperative recurrence of spinal tuberculosis and sinus tract formation; and (2) to summarize the strategy and clinical prognosis of surgical treatments for postoperative recurrence of spinal tuberculosis accompanied by sinus tract formation
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