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Method Article
This study evaluated endoscopic debridement for treating paravertebral abscesses in patients with spinal tuberculosis. Compared to conventional surgery, it significantly improved surgery time, blood loss, hospital stay, pain relief, and neurological outcomes, with fewer complications and no recurrences. These findings highlight its efficacy and safety. Further long-term studies are recommended.
Spinal tuberculosis (TB) remains a significant global health concern, necessitating the development of innovative treatment strategies. This clinical study aimed to evaluate the efficacy and safety of endoscopic debridement as a minimally invasive approach for treating paravertebral abscesses in patients with spinal tuberculosis. A total of 52 patients diagnosed with paravertebral tuberculosis abscesses were enrolled in this retrospective study. Patients were assigned to two groups: the endoscopic debridement group (n = 30) and the conventional open surgery group (n = 22), based on the type of surgery they received. Clinical outcomes were assessed at baseline, post-treatment, and follow-up visits at regular intervals, including surgery time, intraoperative blood loss, total hospital stay duration, pain relief, and neurological improvement. The results of this study demonstrate that endoscopic debridement is a highly effective treatment for paravertebral abscesses in patients with spinal TB. Patients in the endoscopic debridement group experienced significant improvements in surgery time, intraoperative blood loss, total hospital stay duration, pain relief, and neurological improvement compared to those in the conventional open surgery group. Additionally, the endoscopic approach resulted in fewer complications, such as wound infections and postoperative instability, with no cases of recurrence observed during the follow-up period. Therefore, this clinical study highlights the potential of endoscopic debridement as a safe and effective treatment modality for spinal tuberculosis. The technique not only effectively eliminates infected tissue but also ensures faster patient recovery and reduces postoperative complications. Additional research and long-term follow-up studies are necessary to confirm the long-term effectiveness and safety of endoscopic debridement as the standard treatment for spinal tuberculosis.
The risk of tuberculosis is increasing in the last decade due to the rise in drug-resistant tuberculosis bacterial strains and the prevalence of patients living with HIV. An estimated 10 million new cases of tuberculosis and 1.6 million deaths due to tuberculosis were reported globally in 2021 alone, an increase from 1.5 million in 20201. Tuberculosis of the bone and joints accounts for about 1%-2% of all patients with tuberculosis, and spinal tuberculosis accounts for 50% of all skeletal tuberculosis cases2. Spinal tuberculosis often causes pain and symptoms of systemic tuberculosis poisoning. In severe cases, it can lead to kyphotic deformity due to vertebral erosion, spinal cord injury, and paralysis. Active diagnosis and treatment can help relieve symptoms and create favorable conditions for neural recovery3,4.
The literature on treatments for thoracic and lumbar tuberculosis outlines several protocols, including a regimen of anti-TB drugs such as isoniazid, pyrazinamide, rifampicin, and ethambutol, various surgical approaches like anterior radical debridement with graft fusion or posterior debridement with fusion and fixation, as well as minimally invasive methods. Anti-TB chemotherapy is established as the principal treatment for spinal tuberculosis (ST). Surgery is recommended for cases demonstrating clear vertebral instability, non-response to chemotherapy, increasing spinal deformity, severe neurological deficits, or large paravertebral abscesses (PA) with or without compression of the epidural space. Reports indicate that 10% to 43% of spinal tuberculosis cases are complicated by severe kyphosis and neural functional damage, necessitating surgical treatment primarily to remove the lesion and relieve nerve compression5,6. The goal has always been to choose a safe, effective, and less invasive method for the treatment of spinal tuberculosis7,8. Minimally invasive spine surgeries (MIS) are frequently employed to treat degenerative spinal disorders. Among these, full endoscopic surgeries-an established subset of MIS-are effectively utilized for managing disc herniations and spinal stenosis. Nonetheless, their effectiveness in the debridement of vertebral tuberculosis lesions remains underexplored9,10.
Since January 2016, Urumqi Friendship Hospital has implemented minimally invasive anterior debridement to treat lumbar tuberculosis with paravertebral abscess. To provide a reference for future clinical practice, we compared the results of this unique method with traditional posterior fixation combined with anterior debridement techniques.
All procedures involved in the current study were approved by the ethical committee of Urumqi Friendship Hospital, and all patients agreed to the publication of their clinical material, provided their identity is not revealed. From January 2018 to January 2023, clinical and radiological materials, as well as blood work of patients treated with anterior debridement for lumbar tuberculosis with paravertebral abscess, were retrospectively analyzed. The diagnosis of spinal tuberculosis was confirmed by T-SPOT tests, spinal MRI and CT tests, and tissue acid-fast bacilli culture tests4,7,8. The commercial details of the equipment involved in this study are listed in the Table of Materials.
1. Preoperative preparation
2. Surgical procedure of endoscopic debridement
3. Postoperative care following endoscopic debridement
4. Traditional posterior debridement
5. Postoperative care following traditional posterior debridement
6. Outcome assessment
7. Statistical analysis
Fifty-two patients, including 28 males and 24 females, aged 18 to 73 years (50.2 ± 10.5) were included in the current study. Thirty patients were treated with minimally invasive anterior debridement and fusion (minimally invasive surgery group), while 22 patients underwent traditional open surgery (conventional surgery group). In the minimally invasive surgery group, there were 17 males and 13 females, aged 24-72 years (51.4 ± 9.1), including 18 single vertebral bodies and 12 double vertebral bodies. In the con...
The spine is one of the most common locations for tuberculosis, besides the lungs. If not treated in a timely manner, nerve function can be compromised, potentially leading to paralysis and other complications. The combination of anti-tuberculous drugs and surgical intervention is widely accepted as the approach to treat severe spinal tuberculosis. Surgical treatment is the most direct and effective method for these patients. The purpose of surgical treatment for spinal tuberculosis is to clear the abscess, restore stabi...
The authors declare no competing financial interests or other conflicts of interest.
None.
Name | Company | Catalog Number | Comments |
C-arm fluoroscope | GE Healthcare | https://www.gehealthcare.com/products/surgical-imaging/c-arms-for-orthopedics | |
Endoscope | JIOMAX (Germany) | https://www.joimax.com/en/products/ | used for the surgeical procedure |
SPSS | IBM, Chicago, IL | version 24.0 | software for statistocal analysis |
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