International Orthopaedics

, Volume 36, Issue 2, pp 277–283

Management of drug-resistant spinal tuberculosis with a combination of surgery and individualised chemotherapy: a retrospective analysis of thirty-five patients

  • Litao Li
  • Zehua Zhang
  • Fei Luo
  • Jianzhong Xu
  • Peng Cheng
  • Zheng Wu
  • Qiang Zhou
  • Qingyi He
  • Fei Dai
  • Jian Wang
  • Jinsong Zhang
Original Paper

Abstract

Purpose

Drug-resistant tuberculosis is a major public-health concern globally and can be difficult to manage clinically. Spinal tuberculosis is the most common manifestation of extrapulmonary tuberculosis. However, there have been few reports on the topic of drug-resistant spinal tuberculosis. The aim of this study was to investigate the clinical characteristics and drug susceptibility patterns and the outcomes of management with a combination of surgery and individualised chemotherapy, for drug-resistant spinal tuberculosis.

Methods

We retrospectively analysed 35 patients with drug-resistant tuberculous spondylitis. After surgery, individualised chemotherapy was tailored for each patient according to the drug-resistance profile and previous history of chemotherapy. The patients were followed up clinically and radiologically for an average period of 35.8 months.

Results

Among 35 drug-resistant spinal tuberculosis cases, 13 were retreatment cases. Twelve were multi-drug resistant tuberculosis (MDR-TB), and 23 were non-MDR-TB. The patients with MDR-TB and non-MDR-TB had undergone previous chemotherapy for an average of 14.50 ± 2.00 (0–60) months and 4.56 ± 1.54 (0–74) months, respectively. A total of 32 cases underwent open operations, and the other three had percutaneous drainage and local chemotherapy. Patients received individualised chemotherapy for an average of 23.6 months postoperatively. Local recurrence was observed in six patients. Thirty-three patients had been cured at the final follow-up, and the other two were still receiving chemotherapy.

Conclusions

Drug-resistant tuberculous spondylitis is mainly acquired through previous irregular chemotherapy and the spreading of drug-resistant strains. Management with a combination of surgery and individualised chemotherapy is feasible in the treatment of severe complications and the prevention of acquired drug resistance.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Litao Li
    • 1
  • Zehua Zhang
    • 1
  • Fei Luo
    • 1
  • Jianzhong Xu
    • 1
  • Peng Cheng
    • 1
  • Zheng Wu
    • 1
  • Qiang Zhou
    • 1
  • Qingyi He
    • 1
  • Fei Dai
    • 1
  • Jian Wang
    • 2
  • Jinsong Zhang
    • 1
  1. 1.Department of Orthopaedics, Southwest HospitalThird Military Medical UniversityChongqingPeople’s Republic of China
  2. 2.Department of Radiology, Southwest HospitalThird Military Medical UniversityChongqingPeople’s Republic of China

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