Department of Orthopaedics, Zhoukou Orthopedic Hospital, Eastern Taihao Road, Zhoukou City, Henan Province, China.
Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China.
BMC Musculoskelet Disord. 2022 Jun 18;23(1):589. doi: 10.1186/s12891-022-05545-w.
There are considerable differences in the treatment strategy for spinal tuberculosis, including conservative or surgical procedures. Conservative treatment is always suitable for most patients. This study aimed to compare the clinical efficacy of traditional conservative treatment with CT-guided local chemotherapy strategy of mild spinal tuberculosis.
This research retrospectively analysed 120 patients with spinal tuberculosis between January 2005 and January 2016 according to the diagnostic criteria of mild spinal tuberculosis. In total, 89 patients underwent traditional conservative treatment, 31 underwent CT-guided local chemotherapy. Clinical outcome, laboratory indexes, and radiological results were analysed to provide a clinical basis for the choice of mild spinal tuberculosis treatment.
All cases achieved a clinical cure with 24 to 50 months followed up. Cobb angle of the two groups spinal tuberculosis segments was 6.25 ± 3.1100B0, 5.69 ± 2.5800B0 before treatment and 12.36 ± 6.3100B0, 14.87 ± 7.2600B0 after treatment, respectively. The VAS scores were significantly decreased post-treatment. At the 1 month follow-up, the VAS scores and erythrocyte sedimentation rate (ESR) were significantly differences between the two groups. The efficacy in the CT-guided local chemotherapy (Group B) was better than the traditional conservative treatment (Group A). But from the 3 months follow-up to the last follow-up, the VAS scores and ESR was no significant differences between the two groups and the average ESR decreased to normal. There was no evident kyphosis, symptoms or neurological deficits at the final follow-up. The paravertebral abscesses had disappeared, with no significant progression of local kyphosis, significant absorption and clear lesion edges, pain relief and normal ESR in the two groups.
For mild spinal tuberculosis, traditional conservative treatment can achieve satisfactory results. The strategy combined with CT-guided local chemotherapy treatment is minimally invasive, beneficial for the drainage of paravertebral abscesses and pain relief.
脊柱结核的治疗策略存在较大差异，包括保守或手术治疗。保守治疗通常适用于大多数患者。本研究旨在比较传统保守治疗与 CT 引导下局部化疗治疗轻度脊柱结核的临床疗效。
本研究回顾性分析了 2005 年 1 月至 2016 年 1 月根据轻度脊柱结核的诊断标准诊断的 120 例脊柱结核患者。其中 89 例采用传统保守治疗，31 例采用 CT 引导下局部化疗。分析临床疗效、实验室指标和影像学结果，为轻度脊柱结核的治疗选择提供临床依据。
所有病例均经 24 至 50 个月随访，临床治愈。两组脊柱结核节段 Cobb 角治疗前分别为 6.25 ± 3.1100B0 和 6.25 ± 3.1100B0，治疗后分别为 12.36 ± 6.3100B0 和 14.87 ± 7.2600B0。两组治疗后 VAS 评分均明显降低。治疗后 1 个月，两组 VAS 评分和红细胞沉降率（ESR）均有显著差异。CT 引导下局部化疗组（B 组）疗效优于传统保守治疗组（A 组）。但从 3 个月随访到最后随访，两组 VAS 评分和 ESR 无显著差异，平均 ESR 降至正常。末次随访时无明显后凸畸形、症状或神经功能缺损。两组均无明显椎旁脓肿，局部后凸无明显进展，病变边缘明显吸收，疼痛缓解，ESR 正常。
对于轻度脊柱结核，传统保守治疗可取得满意效果。CT 引导下局部化疗联合治疗策略微创，有利于椎旁脓肿引流和缓解疼痛。
