Comprehensive treatment of tuberculous spondylitis with short course pre-operative anti-tuberculosis therapy

Abstract

The objective: to increase the effectiveness of treatment of patients with tuberculous spondylitis by using short course pre-operative anti-tuberculosis therapy.Subjects and methods. Experimental and clinical studies have been performed. The experiment was carried out on 40 guinea pigs by making a model of tuberculous spondylitis in 30 of them. In the clinic, the effectiveness of short course pre-operative anti-tuberculosis therapy with second line drugs, radical decompression plastic interventions using a sliding titanium cage was studied in 30 patients with tuberculous spondylitis versus 30 patients in whom classical methods of preparation and surgical intervention were used.Results. The created model of experimental tuberculous spondylitis made it possible to study parameters of the clinical and morphological course of the disease. The results obtained substantiated the effectiveness of short course pre-operative anti-tuberculosis therapy without the risk of generalization of the disease after radical surgery.The method of surgical treatment of tuberculous spondylitis used in patients and utilizing telescopic titanium cages against the background of short course pre-operative anti-tuberculosis therapy, taking into account the drug resistance of Mycobacterium tuberculosis and therapy continuation after surgery, significantly improved the frequency of excellent treatment results (up to 54.0% versus 32%). At the same time, the period of preparation for radical surgery was significantly reduced, the frequency of complications went down to 13.3% versus 33.3%, the period of in-patient treatment decreased to 96 ± 12 bed-days versus 190 ± 21 (p < 0.01), and the chances of social rehabilitation of operated patients improved.

Keywords

• туберкулезный спондилит
• передний спондилодез
• оперативное лечение