[New technologies in the surgical treatment of tuberculous spondylitis]

The paper deals with surgical treatment in 452 patients with tuberculous spondylitis. The process involved the cervical, thoracic, thoracolumbar, and lumbar parts in 40 (8.8%), 185 (41.0%), 75 (16.8%), and 11 (2.5%) cases, respectively. The active process was found in 125 (27.6%) patients, its loss was detected in 131 (29.1%) cases; the process abated in 196 (43.3%) patients. There were its complicated forms in 341 (75.4%) patients, para- and prevertebral abscesses in 183 (40.4%), epidural abscesses in 26 (5.6%), pareses and paralyses in 71 (15.7%), fistulas in 38 (8.4%), and membranous symptoms in 23 (5.1%). The diagnosis of tuberculous spondylitis was established up to month 3, in 109 (24.1%) patients, up to month 6 in 208 (46.0%), at months 9-12 in 74 (16.4%), at month 12-18 in 61 (13.5%). The concomitant tuberculous involvement of the lung, pleura, kidneys, joints, lymph nodes, and genitals was observed in 139 (30.7%) patients. The resistance of Mycobacteria tuberculosis to antituberculous drugs (streptomycin, isoniazid, and rifampicin) was detected in 139 (30.7%) patients. Of them, 40 (28.8%) patients were unresponsive to two drugs or more. This group of patients received a combined therapy with lomefloxacin and mycobutin on an individual basis. Surgery was made in all the patients; posterior approaches were applied to 44 (9.7%) patients, in 368 (81.4%) anterior approaches were applied to extrafocal apparatus fixation in combination with autograft corporadesis (n = 70), in combination of an autograft and a biocompatible implant with benemycin application (n = 298). The use of these new technologies may expand the scope of operability, reduce surgical traumaticity, initiate early (at day 7-12) rehabilitation of patients, achieve good and satisfactory clinical and functional results by months 4-8 in 81.1% of cases.