I. What cases of spinal tuberculosis can be treated without surgery?
1, early lesions, more limited in scope, vertebral body destruction is not serious, only minor surface damage.
2. There is no local deformity, nerve compression, dead bone or sinus tract formation.
For patients with the above conditions, simple drug therapy can be considered, and if combined with abscess formation, abscess placement and drainage, irrigation and drug injection can be performed under CT guidance, but the CT of the lesion must be reviewed every month in addition to the regular program review to comprehensively evaluate the treatment effect. If the local lesion deteriorates beyond the above conditions the treatment plan should be changed in time.
Second, in what cases of spinal tuberculosis must be treated surgically?
1.Severe destruction of the vertebral body, and the stability of the spine is affected.
2, local deformity, nerve compression 3, dead bone, sinus tract formation.
Patients with the above conditions must undergo surgery.
Third, what preparation is needed before surgery?
1. Routine general physical examination to exclude contraindications to surgery.
2.Intensive basic anti-tuberculosis treatment for 2~4 weeks (2 weeks for combined paraplegia, 4 weeks for non-paraplegia) to limit the lesion, improve the success rate of surgery and reduce the recurrence rate.
3. Pay attention to supplemental nutrition to enhance physical fitness and lay the foundation for post-surgical rehabilitation.
IV. What are the ways of surgery?
1.Bone grafting after lesion removal: It is suitable for those cases with no deformity, vertebral defect less than 1/3 after lesion removal, and the stability of the spine is not affected.
2.Bone grafting and internal fixation after lesion removal: for cases with deformity, vertebral body defect greater than 1/3 after lesion removal, and spinal stability is obviously affected.
V. What should I pay attention to in the rehabilitation treatment after surgery?
1.A regular anti-tuberculosis drug treatment must be adhered to for 1 year after surgery.
2.Regular monthly review for more than 1 year.
3. 2 weeks after surgery, you can wear a protective brace to get out of bed (depending on the recovery of paraplegic patients) and gradually return to self-care, and after 1 year, you can gradually perform light physical labor.
4.Avoid heavy physical work.
Is it necessary to remove the internal fixation?
If some postoperative complications do not occur (such as: local infection, lesion recurrence, screw loosening and displacement to compress adjacent important structures, internal fixation fracture, etc.), the internal fixation does not need to be removed.
VII. What is the role of internal fixation?
Internal fixation can correct the spinal deformity, restore the normal shape of the spine, rebuild the stability of the spine, and enable the patient to get out of bed early after surgery. In addition, it can fix the bone graft to avoid its displacement and improve the fusion rate between the bone graft and the healthy bone tissue at both ends.