1. Do all spinal tuberculosis require surgery?
Not all tuberculosis of the spine requires surgery. Patients with early, primary treatment, no severe bone destruction, no huge abscess and no nerve tissue compression can be cured by chemotherapy with anti-tuberculosis drugs. Anti-tuberculosis drugs and braking remain the first choice for the treatment of spinal tuberculosis.
2.What cases of spinal tuberculosis require surgical treatment? Is surgery necessary to treat spinal tuberculosis only after the tuberculosis has been cured?
The recognized absolute indications for surgery for spinal tuberculosis include: (1) bone destruction affecting spinal stability; (2) progressively worsening paralysis with nerve tissue compression; and (3) progressively worsening kyphotic deformity. Relative surgical indications include cold abscesses, flow formation, large dead bone and vertebral cavities, and persistent tuberculous sinus tracts. The goals of surgical treatment of spinal tuberculosis are to remove the tuberculous lesion, relieve nerve compression, and reestablish spinal stability. Surgery for spinal tuberculosis is part of the treatment of tuberculosis, and the key is to save nerve function and rebuild the stability of the spine, which cannot wait until the systemic tuberculosis is cured.
3.Is surgery still necessary for paraplegia due to spinal tuberculosis?
Paraplegia due to spinal tuberculosis is an absolute indication for surgery. There are two types of paraplegia caused by spinal tuberculosis: one is pathological fracture caused by destruction of the vertebral body by tuberculosis abscess, and paraplegia caused by protrusion of the abscess into the spinal canal and compression of the spinal cord, or compression of the spinal cord caused by distortion of the spinal canal, which can cause paralysis in a short period of time; the other is destruction of the vertebral body caused by tuberculosis lesion, and even if it is cured by anti-TB treatment, the progressive aggravation of the retroflexion deformity can still occur over time, and the patient slowly The patient slowly develops symptoms of paralysis. Both cases require surgery, which can relieve the nerve tissue compression, correct the kyphosis, rebuild the stability of the spine, and provide conditions for the recovery of spinal cord function.
4.Why do I need anti-tuberculosis treatment before surgery? How long is the treatment needed?
Pre-operative anti-tuberculosis treatment is necessary to effectively control the symptoms of tuberculosis intoxication, reduce the probability of tuberculosis dissemination, and enhance the effect of surgical removal of tuberculosis lesions. Preoperative oral anti-TB medication for 2 to 4 weeks is a common regimen, and effective anti-TB treatment is the cornerstone of surgical treatment of spinal TB. Clinical indicators used to evaluate the effectiveness of anti-TB treatment include (1) control of TB toxicity symptoms such as fever and night sweats; (2) improvement in appetite and weight gain; (3) reduction of blood sedimentation and C-reactive protein to normal levels or a significant decrease; and (4) reduction of spinal pain symptoms. However, for patients with spinal tuberculosis who suddenly develop paralysis, anti-tuberculosis drug therapy can be arranged intraoperatively and postoperatively in order to salvage neurological function. In addition, for patients with stubborn spinal TB lesions (especially huge TB abscesses), who still have fever, high blood sedimentation and C-reactive protein after anti-TB drug treatment, surgery can also be taken in a timely manner according to the patient’s actual condition and the doctor’s comprehensive judgment.
5.Why do I need to take anti-tuberculosis drugs after surgery? How long do I need to take them?
Spinal tuberculosis is a local manifestation of systemic tuberculosis, and it is impossible to completely remove tuberculosis bacteria by surgery. Surgery is only an adjunct to the treatment of tuberculosis of the spine, but effective drug therapy is essential to kill the tuberculosis bacteria. There are three clinical regimens of anti-tuberculosis treatment, depending on the duration of drug administration: ultra-short course chemotherapy (4-6 months), short course chemotherapy (6-9 months) and standard chemotherapy (18 months). Flexible and individualized treatment regimens should be used based on patient imaging, laboratory tests and follow-up. In conclusion, once anti-tuberculosis chemotherapy is started, the drug must be stopped only after the tuberculosis has been cured by multiple test results.
6.What are the effects of unauthorized drug reduction or discontinuation after surgery?
Unauthorized reduction or discontinuation of medication after surgery can have serious consequences, with a high risk of TB failure or relapse. The patient is prone to drug resistance to anti-tuberculosis chemotherapy again, which often requires replacement of more potent drugs and prolongs treatment time, increasing the difficulty of treatment and the financial burden on the patient.
7.What are the ways of surgical treatment of spinal tuberculosis?
At present, the surgery for the treatment of spinal tuberculosis is diversified and individualized according to the degree of destruction of the spine by tuberculosis: spinal tuberculosis with no obvious bone destruction and “cold abscess” as the main manifestation can be drained by puncture under ultrasound or CT positioning, and open surgery is not required, but the indications need to be strictly grasped. In accordance with the development of spinal tuberculosis treatment, the following surgical approaches have been developed: simple anterior lesion removal and bone grafting, anterior lesion removal and bone grafting, anterior lesion removal and bone grafting combined with posterior fixation, and simple posterior lesion removal and bone grafting. The surgical approach used in a specific case is often based on the individual patient’s condition and the surgeon’s familiarity with the surgical approach.
8.Does all spinal tuberculosis surgery require bone grafting? Is it done with my own bone or artificial bone?
Although not all spinal tuberculosis surgeries require bone grafting, bone fusion is indeed an important tool and purpose of spinal tuberculosis surgery. Bone graft materials commonly used in clinical practice today include autologous bone, allogeneic bone, xenogeneic bone and other biological bone materials. Autologous iliac bone is recognized as the best bone grafting material and the “gold standard” for spinal tuberculosis bone grafting. However, patients’ fear of autologous bone extraction, secondary trauma caused by autologous bone extraction, and chronic pain in the bone donor area limit the use of autologous bone; other alternative bone graft materials are increasingly used and can generally achieve the purpose of bone graft fusion.
9.When is internal fixation required for spinal tuberculosis? What is the use of internal fixation?
When spinal tuberculosis causes bone destruction of the vertebral body, loss of spinal stability, or large bone defects after surgical removal of the lesion, bone grafting and internal fixation are needed to rebuild the stability of the spine. The internal fixation is more stable and reliable than the traditional external fixation, which provides a good bone growth environment for bone grafting, corrects the kyphosis and prevents the secondary kyphosis, and restores the normal force line of the spine.
10.Does the internal fixation need to be removed? What are the effects of removing or not removing?
At present, the spinal internal fixation system is mostly made of titanium alloy, with good biocompatibility and rare rejection. On the contrary, it is necessary to remove the internal fixation or perform revision surgery.