Treatment of spinal tuberculosis with ultrashort-course chemotherapy in conjunction with partial excision of pathologic vertebrae

BACKGROUND CONTEXT: The ultrashort-course chemotherapeutical scheme of less than 6 months has been used for part of patients with pulmonary tuberculosis and satisfactory curative effects have already been achieved. However, few systematic and clinical reports so far about medical treatment of spinal tuberculosis by using ultrashort-course chemotherapeutical schemes have been published in the spine-care literature. PURPOSE: To assess the results of ultrashort-course chemotherapy (UCC) in conjunction with partial excision of pathological vertebrae for spinal tuberculosis. STUDY DESIGN/SETTING: This is a retrospective comparative study of case series from a single center. PATIENT SAMPLE: Seventy-six cases of spinal tuberculosis, treated during 1998 and 2003 by senior author, were reviewed. All the cases underwent chemotherapies in conjunction with the uniform partial excision of pathological vertebra and had a minimum follow-up of 2 years. OUTCOME MEASURES: Clinical manifestations, laboratory tests, imaging examination, examination by ultrasonic wave B, drug complications, and clinical effects based on the previously described evaluative measures. METHODS: Of the 76 cases, 28 had UCC with the scheme of 2SHRZ/2.5H(2)R(2)Z(2), 23 had short-course chemotherapy (SCC) with the scheme of 3SHRZ/5H(2)R(2)Z(2), and 25 had standard chemotherapy (SC) with the scheme of 3SHRZ/9H(2)R(2)Z(2). All the patients had anterior partial excisions of pathological vertebrae, large iliac strut graft, and anterior or posterior fixation. The mean time of follow-up surveys for the ultrashort-course, short-course, and standard chemotherapy cases was 42.3 m, 46.5 m, and 55.4 m, respectively. RESULTS: The observance indices included 1) clinical manifestations: disappearance of tuberculosis symptoms, no CC pains, recovery of normal life or work, no percussion pains on pathologic sites, and recovery of neural functions; 2) laboratory tests: normal or close to normal test results of both erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) or one of them; 3) imaging examinations: X-ray films, computed tomography scan, and magnetic resonance imaging examinations show disappearance of abscesses, no new destructive foci, bone union on the bone grafting interface, satisfactory correction of deformities, and less than 5 degrees of the angle loss of deformity corrections; 4) examination by ultrasonic wave B: no opaque dark area of fluid sonolucent areas identified in possible sites of paravertebral abscesses or gravitation abscesses; and 5) drug complications: hepatic and renal functions, nervus vestibularis lesion, and gastrointestinal tract reactions. All the cases met the protetrakis indices and obtained complete clinical cure of spinal tuberculosis in the last follow-up. The significant differences of major drug complications were found among the 3 groups, with 5 cases of UCC (18%), 15 cases of SCC (65%), and 19 cases of SC (76%).The lasting chemotherapeutic lesion of liver, kidney, or the permanent nervus vestibularis lesion were found 3 cases in SCC, 5 cases in SC, and no case in UCC group. CONCLUSIONS: No significant differences in clinical cure rate were found among 3 groups. UCC in conjunction with anterior partial excisions of pathological vertebrae, large iliac strut graft, and anterior or posterior internal instrumental fixation achieved excellent clinical results and the lowest complication rate of antituberculosis chemotherapy.