[Comparison of inter- and intra-observer reliability between GATA and SMU classification systems for spinal tuberculosis].

OBJECTIVE: To compare the inter- and intra-observer reliability of the GATA and SMU classification systems for spinal tuberculosis and assess the clinical value of SMU classification. METHODS: One hundred patients with spinal tuberculosis treated in our hospital from January 2004 to December 2011 were randomly selected for analysis, including 54 males and 46 females with a mean age of 45 years (range, 16-68 years). All the patients had X-ray, CT and MRI examinations. Five observers experienced in spinal tuberculosis independently assigned the classification using the GATA and SMU classification systems, and the assignment was repeated 3 months later to test its reproducibility. Kappa value was used to determine the intra- and inter-observer reliability. RESULTS: For GATA and SMU classification systems, the inter-observer percentage of agreement averaged (59.9∓4.84)% (κ=0.412∓0.058) and (81.6∓6.06)% (κ=0.753∓0.068), and the intra-observer percentage of agreement was (75.6∓5.27)% (κ=0.624∓0.078) and (89.8∓2.28)% (κ=0.862∓0.037), respectively. CONCLUSION: The SMU classification system of spinal tuberculosis has a higher inter-observer and intra-observer reliability than the GATA classification system, but its clinical value needs to be further tested in future clinical trials.

[Complications of the anterior surgical approach for thoracolumbar spine tuberculosis: causes and countermeasures].

OBJECTIVE: To assess the effect of the anterior surgical approach for thoracolumbar spine tuberculosis and analyzed the causes of the surgical complications and the countermeasures. METHODS: From Jan 1996 to Dec 2005, 120 patients with thoracolumbar spine tuberculosis underwent operations through the anterior approach either following the primary diagnosis (115 cases) or for recurrence (5 cases). RESULTS: Intraoperative pleural rupture occurred in 4 cases, and rupture of the external iliac vein occurred 1 case. Three patients had damages of the T12 dorsal ramus. One patient developed venous embolism of the lower extremity after the operation, two had paralytic ileus and 1 had false diabetes insipidus. Of the 5 recurrent patients, 1 died due to alcoholic cirrhosis and acute liver failure, 1 received a third operation for loosened internal fixation, and 1 had recurrence due to extensive drug resistance (XDR). CONCLUSION: Standardized antituberculous therapy is fundamental for preventing the recurrence of tuberculosis, and individualized antituberculous therapy adjustment according to the results of bacterial culture and drug sensitivity tests can be the most effective means for preventing drug resistance and reducing tuberculosis recurrence.