How to determine the course of preoperative chemotherapy for spinal tuberculosis: A single-center clinical study

Abstract

Objective This study aims to explore the clinical efficacy and feasibility of preoperative 1-week chemotherapy for patients with spinal tuberculosis undergoing complete lesion removal. Methods Clinical data of 76 patients with spinal tuberculosis who underwent complete focal debridement in our hospital were collected from June 2020 to September 2023. The patients were divided into 38 cases of preoperative 1-week chemotherapy group (Group A) according to the length of preoperative chemotherapy, with 23 males and 15 females aged 48 ± 15.8 years (19–81 years old); and 38 cases of preoperative 2–4-week chemotherapy group (Group B), with 21 males and 17 females aged 48 ± 18.9 years (15–75 years old). The preoperative chemotherapy regimen was standard quadruple antituberculosis drug therapy and included the following: isoniazid (Isoinazid INR, 5 mg/kg/d), rifampicin (RifampicinRFP, 10 mg/kg/d), ethambutol (Ethambutol EMB, 15 mg/kg/d), pyrazinamide (Pyrazinamide.PZA, 20 mg/kg/d). All patients underwent phase I complete lesion removal. Perioperative related, imaging, and laboratory examination indices as well as postoperative neurological function recovery, postoperative pain recovery, related complications, and clinical efficacy were analyzed between the two groups to compare the clinical efficacy of different preoperative chemotherapy time for the treatment of spinal tuberculosis. Results All patients successfully completed the treatment of stage I complete lesion removal combined with bone grafting fusion and internal fixation, of which 23 cases in group A had operation time of 243.7 ± 77 min (120–440 min) and intra-operative hemorrhage of 393 ± 111.1mL (200–600 mL); meanwhile, 30 cases in group B had operation time of 193.9 ± 66min (90–300) min and intraoperative hemorrhage of 426 ± 177.9 mL (200–1000 mL). The difference in the operation time and intraoperative hemorrhage between the two groups was not statistically significant (P > 0.05). ESR and CRP decreased significantly in January after surgery in the two groups, and the difference was statistically significant (P < 0.05). The difference in ESR and CRP at the same postoperative observation time between the two groups was not statistically significant (P > 0.05). The VAS scores of patients in the two groups decreased significantly with prolonged time, and the difference was statistically significant (P < 0.05). All patients achieved satisfactory clinical efficacy (P < 0.05). All patients achieved good clinical outcomes, the difference between the groups was not statistically significant (P > 0.05). The difference in incision healing rate at 3 months postoperatively and bone graft fusion rate at 6 months postoperatively was not statistically significant between the two groups (P > 0.05). The dissemination and recurrence of Mycobacterium tuberculosis was not statistically significantly different between the two groups after surgery (P > 0.05). The neurological functions of patients in both groups were well recovered, and no cases of death and spinal cord damage were recorded in the follow-up of all patients. Conclusion With complete lesion clearance, 1 week of preoperative chemotherapy is feasible in patients with spinal tuberculosis with varying degrees of neurological dysfunction.