Chemotherapy in anterior instrumentation for spinal tuberculosis: highlighting a 9-month three-drug regimen

Anterior instrumentation has been used for surgical treatment of spinal tuberculosis, but there are different regimens of antituberculous chemotherapy used in combination with surgical intervention. The objective of this prospective study was to determine the efficacy of an antituberculous chemotherapy regimen by following a series of patients with spinal tuberculosis, for a minimum of 3 years, who underwent single-stage anterior radical debridement, autogenous bone grafting, and instrumentation.

The clinical and radiographic outcomes of these patients were analyzed with special reference to postoperative chemotherapy with a 9-month three-drug regimen. A total of 57 consecutive patients were treated surgically with single-stage anterior radical debridement, autogenous bone grafting, and instrumentation between 1999 and 2004. These patients received postoperative antituberculous chemotherapy with a 9-month three-drug regimen of isoniazid, rifampicin, and ethambutol. They were followed for 3-8 years (average = 5.5 years) with clinical and radiologic outcomes examined at each follow-up visit.

All patients received postoperative chemotherapy for 9 months except two for whom postoperative chemotherapy was discontinued 4 and 6 months after surgery because of noncompliance. All patients experienced complete or significant relief of cervical or back pain, rapid improvement of neurologic function, and kyphotic correction. Bony fusion and eradication of the infection were achieved in all patients, with no recurrence of the tuberculosis.

In conclusion, postoperative chemotherapy with the 9-month three-drug regimen of isoniazid, rifampicin, and ethambutol is effective when combined with surgical treatment of spinal tuberculosis using single-stage anterior autogenous bone grafting and instrumentation.