Report on the clinical outcomes of using postural drainage with intervertebral space as the main focus for managing thoracolumbar tuberculosis: Eight case reports.

RATIONALE

Conservative treatment has shown limited effectiveness in managing thoracolumbar tuberculosis (TB) that extends to the intervertebral space, as antibiotics are unable to penetrate avascular intervertebral discs, while conventional surgery is known for its extensive trauma and slow healing process.

PATIENT CONCERNS

Infection of the thoracic and lumbar vertebrae with tuberculosis can lead to difficulties in treatment due to involvement of the intervertebral space.

DIAGNOSIS

The diagnosis of TB was confirmed through clinical manifestations, impact studies, and T-spot experiments.

INTERVENTIONS

A retrospective analysis was conducted on the clinical data of 8 patients with thoracolumbar spinal TB who underwent postural drainage focusing on the intervertebral space as a treatment from June 2012 to August 2019. The average duration of treatment was 7.75 ± 10.19 months. Among the patients, there were 2 cases of thoracolumbar and 6 cases of lumbar spine involvement, with 6 cases affecting a single segment and 2 cases involving 2 segments. The total number of affected vertebrae included 4 thoracic, 12 lumbar, and 2 sacral vertebrae. All patients received standardized quadruple antituberculosis treatment (HRZE scheme). Specific postural drainage paths and catheter placement locations were determined based on clinical imaging results, and percutaneous catheter placement was performed with the assistance of foraminoscopy. Erythrocyte sedimentation rate, C-reactive protein, Visual Analogue Scale score, American Spinal Cord Injury Association score, and Oswestry function index were statistically analyzed before, after postural drainage, and at the final follow-up.

OUTCOMES

The average operation time was 44.38 ± 10.50 minutes, with a blood loss of 6.88 ± 2.59 mL. The average catheter drainage time was 13.25 ± 4.95 days, and the follow-up period ranged from 36 to 122 months. The average total drainage volume was 281.25 ± 167.69 mL. Significant improvements were observed in erythrocyte sedimentation rate, C-reactive protein, Visual Analogue Scale score, American Spinal Cord Injury Association score, and Oswestry functional index at 7 days after postural drainage and at the last follow-up compared to before postural drainage (P < .05). At the last follow-up, there were 8 cases with no recurrence reported among the patients.

LESSONS

The utilization of positional drainage in the intervertebral space, coupled with chemotherapy, has demonstrated encouraging clinical results and may be deemed appropriate for treatment.