Lifeso R M, Weaver P, Harder E H
J Bone Joint Surg Am. 1985 Dec;67(9):1405-13.
We treated 107 adults with spinal tuberculosis. The average age was 41.8 years (range, sixteen to seventy-five years). Diagnosis was difficult: bone scans were negative in 35 per cent; gallium scans, negative in 70 per cent; and results of tuberculin skin tests, negative in 14 per cent. Five neurologically impaired patients had no discernible bone lesions when they were first seen but were found to have either intradural or extradural tuberculomas or tuberculous arachnoiditis. Our indications for a spinal operation were neurological impairment, spinal instability, or failure of medical management, and an operation was required in fifty-three of the 107 patients. Anterior decompression and fusion was the surgical procedure of choice. Ninety-four per cent of neurologically impaired patients recovered normal neurological function after anterior decompression; 79 per cent, after non-surgical treatment; and 55 per cent, after laminectomy. Neurological recovery and relief of pain occurred more rapidly in the surgically treated group. Kyphosis did not worsen in any patient, whether treated medically or surgically. There were no organisms that were resistant to isoniazid, rifampin, or ethambutol, and there was neither progression nor reactivation of disease after twelve months of adequate chemotherapy.
我们对107例成人脊柱结核患者进行了治疗。平均年龄为41.8岁（范围为16至75岁）。诊断困难：骨扫描阴性者占35%；镓扫描阴性者占70%；结核菌素皮肤试验结果阴性者占14%。5例有神经功能障碍的患者初诊时未见明显骨病变，但后来发现有硬膜内或硬膜外结核瘤或结核性蛛网膜炎。我们进行脊柱手术的指征是神经功能障碍、脊柱不稳定或内科治疗无效，107例患者中有53例需要手术。前路减压融合术是首选的手术方式。94%有神经功能障碍的患者在前路减压后恢复了正常神经功能；非手术治疗后恢复正常神经功能的比例为79%；椎板切除术后为55%。手术治疗组神经功能恢复和疼痛缓解更快。无论接受内科治疗还是手术治疗，所有患者的脊柱后凸均未加重。未发现对异烟肼、利福平或乙胺丁醇耐药的菌株，在进行12个月的充分化疗后，疾病既无进展也无复发。
