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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.

BACKGROUND: Ten percent of all tuberculosis patients may develop skeletal involvement, and the spine is the most common anatomical location. Tuberculous spondylitis is further complicated by the fast-acid bacilli resistance to the usual chemotherapy regimen (multidrug-resistant/MDR) and its complications. In this case series, we would like to present three MDR tuberculous spondylitis cases effectively treated with tailored chemotherapy regimens and surgical interventions. CASE REPORT: A series of three patients with MDR tuberculous spondylitis is presented. All three patients presented with back pain, lump, and weakness of both lower extremities. These cases were resolved with a combination of surgical intervention and tailored chemotherapy regiment after MDR resistant detected. Two cases were resolved completely, and only one patient had residual paresthesia on his legs. CONCLUSION: A combination of MDR antituberculous chemotherapy and surgical intervention leads to an excellent outcome, in which the patient can perform regular daily tasks without pain, even in complicated MDR tuberculous spondylitis cases.

AbstrakOsteomyelitis sampai saat ini masih menjadi masalah baik pada usia anak maupun dewasa. Sulitnya deteksi dini menjadikan banyak kasus akut menjadi kronis sehingga semakin sulit penatalaksanaanya. IL-1 memiliki peranan sangat penting dalam proses penyembuhan fraktur. Pada penelitian ini ingin diketahui kadar IL-1 pada fase inflamasi osteomyelitis fraktur tulang femur dengan intramedula pinning dan gips sirkular. Desain penelitian ini adalah eksperimental laboratoris dengan post test only control group design menggunakan hewan coba tikus sebanyak 20 ekor yang terbagi menjadi kelompok infeksi dan non infeksi. Pengukuran kadar IL-1 serum dilakukan pada hari ke-1, ke-3, dan ke-7 dari daerah fraktur tulang femur. Kondisi osteomyelitis dibuat dengan menginjeksikan Staphylococcus aureus sebanyak 10 6 CFU dengan metode ELISA. Analisis statistik menggunakan uji ANOVA dilanjukan dengan uji Tukey menunjukkan bahwa kadar IL-1 meningkat signifikan pada hari ke-3 pada kelompok infeksi dibanding kelompok non infeksi (p < 0,01). Dapat disimpulkan bahwa osteomyelitis pada fraktur tulang femur dengan intramedula pinning dan gips sirkular terbukti meningkatkan kadar IL-1 serum.Kata kunci: fraktur femur, IL-1, osteomyelitis, gips sirkular, intramedula pinning LEVEL OF INTERLEUKIN-1β ON INFLAMMATORY OSTEOMYELITIS IN FEMORAL FRACTURE RAT (Rattus norvegicus) WITH INTRAMEDULLARY PINNING AND CIRCULAR GIPS AbstractNowadays, osteomyelitis is still being a popular problem among children and adults. Difficulties for early detection of acute cases increase the potential of this cases to be chronic cases, so it becomes more difficult to treat. IL-1 have the most important role in fracture healing process. The study was aimed to measure the level of IL-1 on inflammatory osteomyelitis in femoral fracture with intramedullary pinning and circular gips. The research design was laboratory experimental study using post test only control group design. Twenty rats employed as animal models that were divided into infection and non infection groups. The IL-1 serum level was measured by ELISA method on day 1, 3 and 7. Osteomyelitis femoral bone fracture induced by Staphylococcus aureus 10 6 CFU. Statistical analysis using ANOVA continued by Tukey test showed that level of IL-1 increased significantly on day 3 in infected group compared to non infected group (p < 0.01). Therefore, to be concluded that osteomyelitis in femoral fracture with intramedullary pinning and circular gips shown to increase the serum level of IL-1.