The Role of Instrumentation in the Healing Process of Spinal Tuberculosis: An Experimental Study

Abstract

Introduction: Tuberculosis is still commonly found in many developing countries. Spinal tuberculosis can cause vertebral deformity and neurological disorders. It was discovered thousands years ago and its management was aimed to eradicate infection and maintain the integrity of the vertebrae. Previously, the management of spinal TB was using drugs and external stabilization. Surgical techniques were developed afterwards to clean the infected vertebral segment. Because of the vertebral deformity remained inevitable and had impacts on neurological disorders, new paradigm had been developed by using instrumentation to stabilize the deformity of infected vertebral segment and to restore and maintain neurological function. TGF-β has a major role in angiogenesis in bone healing process. Spinal TB instrumentation uses metal devices composed of ions and particles that can interact each other so it could produce physical and chemical energy that is transmitted to the vertebrae. The energy is expected to enhance the biomolecular and biocellular activity of the body's immune cells so the healing process could be better.
 Methods: An experimental study was carried out on New Zealand Rabbits which were given TB H37Rv strain infection in the vertebral body. Samples were divided into five groups namely control rabbits, infected rabbits without intervention, infected rabbits treated by instrumentation, infected rabbits given anti-tuberculosis drugs and infected rabbits treated by instrumentation and given drugs. Then the cytokine levels of TGF-β were evaluated and compared.
 Results: The results showed a significant TGF- β level increase in infected rabbits given drugs alone and instrumentation alone compared to infected rabbits without intervention. There was a significant TGF- β increase in infected rabbits given drugs and treated by instrumentation compared to control rabbits and rabbits who received drugs only.
 Conclusions: Instrumentation can improve the healing process in spinal tuberculosis by increasing the body's cytokine levels.