The experience in tuberculous spondylitis treatment taking into account the susceptibility of mycobacteria tuberculosis to antibacterial medicines

Abstract

Objective — to increase the effectiveness of treatment of patients with tuberculous spondylitis (TS), to improve the etiological diagnosis and operative treatment of patients with TS. Materials and methods. The data of 60 patients with active TS of the thoracic and lumbar vertebrae, operated in the osteoartikular tuberculosis department of Kharkiv Regional Antituberculosis Dispensary No. 1 and Traumatology and Orthopedics department of Kharkiv Municipal Clinical Emergency Care Hospital named after A.I. Meshchaninov in the period 2014—2019. Patients were divided into the main and control groups (n = 30). The main group includes patients with TS operated with the use of a telescopic titanium cage for ventral interbody spondylodesis after necrosequestrectomy. The group II (control group) included patients treated with using traditional approaches to TS treatment. Results and discussion. Bacteriological confirmation of the diagnosis was obtained in 40.0 % of patients of the control group, of which 20.0 % of mycobacterium tuberculosis (MBT) were isolated only by culture, 13.3 % only by bacterioscopy, and in 6.7 % of cases positive results were obtained using two methods.In patients of the control group, the largest number of positive results was obtained from the contents of abscesses — in 30.0 % of patients, with pus on tampons and secretions from fistulas — in 6.7 % (p < 0.01), from operative material (granulations and caseous masses) — in 16.7 %. Among the patients of the control group, bacteriological confirmation was obtained in 10 (33.3 %) patients.Diagnostic puncture biopsy of vertebral bodies, used in 17 diagnostic patients, made it possible to diagnose cancer metastasis in the vertebral body in one (5.9 %) case, in three (17.6 %) — primary tumors of the spine, in 9 (52.9 %) patients — tuberculosis and 4 (23.6 %) — non-specific osteomyelitis of the spine. This study was performed by the method of diagnostic percutaneous trepanobiopsy of the vertebral bodies with the help of electronic-optical converter through the posterior access through the root of the affected vertebral arch.The long-term results of TS treatment were studied in 26 patients of the main group (86.7 %) and in 25 patients of the control group (83.3 %) in the period from 1 to 10 years. Long-term results of treatment were evaluated using a generally accepted scoring scale. Conclusions. The new method of TS treatment in the main group compared to traditional standards of surgical interventions in the control group allowed: 1) to avoid the progression of TS, the development of complications of the disease (p < 0.05) and complications related to the transplant (fractures, displacement of the autograft, cage) (p < 0.05), in the early postoperative period; 2) significantly increase the effectiveness of treatment due to an increase in excellent results (46.7 and 26.7 %, respectively) and a decrease in satisfactory (13.3 and 23.3 %) and unsatisfactory (0.0 and 10.0 %; p < 0.05) of the results in the remote terms of obser­vation; 3) significantly shorten the inpatient stage of treatment ((96 ± 12) and (190 ± 21) bed-days; p < 0.001).