Retrospective Evaluation of Short-Course versus Traditional Preoperative Chemotherapy in Thoracolumbar Spinal Tuberculosis Patients.

ABSTRACT

BACKGROUND Thoracolumbar spinal tuberculosis is a severe form of extrapulmonary tuberculosis requiring precise management strategies. Traditionally, patients undergo a 2-4 week course of preoperative quadruple chemotherapy before surgery. However, recent clinical practices have begun exploring the potential of a short-course (1-7 days) intensive preoperative chemotherapy regimen. This study aims to examine and compare the clinical effectiveness of both approaches, offering critical insights into the optimal preoperative chemotherapy duration. MATERIAL AND METHODS In this retrospective analysis, we examined the clinical data from 123 patients with surgically treated thoracolumbar spinal tuberculosis. Patients were categorized into two groups based on the duration of preoperative chemotherapy the short-course intensive chemotherapy group (n=53, 1-7 days) and the traditional quadruple chemotherapy group (n=70, 2-4 weeks). We gathered and compared the pertinent clinical data from both groups to ascertain differences in clinical efficacy. RESULTS All 123 patients underwent follow-up for a duration averaging 2.8±0.7 years. Five patients experienced postoperative recurrence. Patients reported significant pain alleviation and overall good clinical outcomes. Among patients with neurological dysfunction, neurological symptoms were ameliorated, and the implanted devices were found to be effective. Bony fusion was observed in all the bone grafting regions. CONCLUSIONS For patients suffering from thoracolumbar spinal tuberculosis exhibiting progressive neurological deterioration, surgical intervention is deemed feasible after a brief period (usually 1-7 days) of intensive preoperative antitubercular therapy. This finding suggests that short-course intensive preoperative chemotherapy may serve as a viable approach in managing such cases.