After surgical treatment of spinal tuberculosis, patients may not be able to rest easy and may be left with some problems such as back pain, drug resistance, and recurrence of the disease. Today, we invited Professor Zhao Jie from the Department of Orthopedics of the Ninth People’s Hospital of Shanghai Jiaotong University Medical College to teach you how to deal with common problems after spinal tuberculosis surgery.
1. What should I do if I have back pain after spinal tuberculosis surgery?
According to Prof. Jie Zhao, back pain in postoperative patients is caused by a variety of reasons, the common ones being.
① Pain from spinal tuberculosis can radiate to the shoulders, arms and back, creating symptoms of nerve irritation and causing back soreness.
(ii) Scars left after surgery, which may stimulate the body to produce back soreness symptoms.
③When treating spinal tuberculosis, in addition to surgery, the patient is braked and rests as much as possible, when the muscles of the lower back are not exercised and muscle function deteriorates, pain occurs.
For the first two causes of back pain, painkillers can be taken after surgery to relieve them. As for the third cause, Prof. Jie Zhao believes that patients need to be encouraged to do proper exercise and does not advocate long-term bed rest and no exercise. Because. Even with braking and bed rest, it is not complete immobility, and patients need to turn over when lying in bed.
Thirty years ago, patients were braked and put in a plaster bed for the treatment of spinal tuberculosis, but this method was so painful that it is not used now. Instead, patients are put in a plaster undershirt or a head, neck, and chest cast and told to get out of bed. This combination of movement and stillness not only treats the disease but also improves muscle function, which is not contradictory.
2.What is a sinus tract? What should I do if a sinus tract forms after surgery for spinal tuberculosis and does not heal?
A sinus tract, in simple terms, is a deep blind canal that opens on the surface of the skin due to the invasion of bone and soft tissues by Mycobacterium tuberculosis, resulting in poor drainage of large amounts of purulent secretions in the body, which initially destroys the deep soft tissues and then gradually invades the skin surface.
For sinus tracts formed after spinal tuberculosis surgery, regular and adequate chemotherapy with anti-tuberculosis drugs (chemotherapy for short) is required, and usually the sinus tracts can heal on their own after three months. However, for persistent sinus tracts, such as sinus tracts that do not show any signs of healing for more than one or two months, a second surgical debridement and suture treatment is required when necessary.
Prof. Zhao points out that if the sinus tract is red, swollen and pus-filled after spinal tuberculosis surgery, more attention needs to be paid to the fact that this is most likely due to a mixed infection. Mycobacterium tuberculosis is a special kind of bacteria, and if the body is infected with other septic bacteria in addition to Mycobacterium tuberculosis, a mixed infection can occur. This mixed infection is very dangerous and can lead to life-threatening complications if not treated properly. Medication is essential for this phenomenon, while surgery requires an indication for surgery – if the patient has an abscess, deformity or nerve compression, the doctor will choose surgery along with medication.
3. Is the hunchback after surgery due to the reappearance of the deformity? Do I need a second surgery if the deformity reappears?
Prof. Zhao Jie said, “The earliest detection and suspicion of spinal tuberculosis is due to the development of posterior convexity deformity, which is commonly known as hunchback. The results of the surgery are different for different patients with spinal tuberculosis. For example, in young patients with spinal tuberculosis, surgery is primarily to improve appearance; in some patients with neurological symptoms due to kyphosis, surgery is used for decompression and orthopedics to improve neurological symptoms; and in other patients with postoperative tuberculosis lesions that are still present, surgery is also needed to keep the lesions quiet. However, not all patients need secondary surgery, and the indications for secondary surgery for spinal tuberculosis are, in theory, more stringent than the first.”
4. Can drug resistance occur when anti-tuberculosis drugs are taken after surgery?
Surgery is only part of the overall treatment plan for spinal tuberculosis, and chemotherapy with anti-tuberculosis drugs is still required after surgery. When chemotherapy is not effective, it suggests the possibility of drug resistance. For example, in some patients, the abscess disappears after surgery, and after taking anti-tuberculosis drugs for several months and feeling good, they stop taking them on their own. This is why doctors are now emphasizing the need for regular and adequate chemotherapy to treat tuberculosis.
In addition, there is a type of bacterium called multidrug-resistant bacterium, which means that it is resistant to all anti-TB drugs. Once drug resistance occurs, you need to seek treatment from a tuberculosis specialist to give a treatment plan.
5. Is spinal tuberculosis prone to recurrence after surgery?
Tuberculosis of the spine, like degenerative lesions, does not have a high recurrence rate. However, patients need to understand that TB is a lifelong disease (not in the sense of requiring lifelong medication, but in the sense that Mycobacterium tuberculosis will always be latent in the body) and cannot be completely removed even with surgery and medication. After a year to a year and a half of regular medication after spinal tuberculosis surgery, the patient is clinically cured, at which point the doctor will instruct the patient to take some precautions.
(i) Regular follow-up visits to check some laboratory indicators, such as blood count and sedimentation.
②Patients should not work too hard, maintain a good lifestyle, and do not allow themselves to have a period of low resistance, otherwise Mycobacterium tuberculosis will take advantage of the situation and induce the disease.