[Surgical treatment of spinal tuberculosis associated with diabetes mellitus].

OBJECTIVE

To investigate the perioperative management and the results of surgical treatment of spinal tuberculosis associated with diabetes mellitus.

METHODS

The clinical data were analysed retrospectively from 42 patients with spinal tuberculosis associated with type 2 diabetes mellitus who were surgically treated between July 2001 and January 2009. There were 22 males and 20 females with an average age of 56.5 years (range, 41-78 years). The disease duration was 4-18 months (mean, 7.5 months). The involved vertebrae included 2 cervical vertebrae, 13 thoracic vertebrae, 17 thoracolumbar vertebrae, and 10 lumbar vertebrae. Of them, 18 patients complicated by paraplegia, and 25 patients had more than one of concomitant diseases. Anterior debridement and bony grafting with anterior instrumentation fixation were performed in 16 patients; anterior debridement and bony grafting with posterior instrumentation fixation in 4 patients; posterolateral costotransversectomy debridement and interbody fusion with posterior instrumentation fixation in 8 patients; posterior debridement and bony grafting with posterior fixation in 7 patients; sinus resectomy and focus debridement in 2 patients; anterior debridement and bony grafting in 3 patients; and CT guided percutaneous catheter drainage in 2 patients. Postoperative anti-tuberculosis treatment was given for 12-24 months.

RESULTS

The patients were followed up 1.5-5.0 years, with a mean period of 3.5 years. One patient died of pulmonary infection after 1 week of operation; 1 patient died of myocardial infarction after 2 years of operation; and other patients survived without tuberculosis recurrence. Among 38 patients who received bony grafting, 34 patients achieved bony fusion, 3 suffered bony grafting failure without kyphotic deformity or instability except 1 patient who died from pulmonary infection. Among 18 cases complicated by paraplegia, nerve function improved to a certain extent. The intraoperative and postoperative complications occurred in 28 cases. The systemic complications mainly included heart insufficiency in 5, heart arrhythmia in 3, pulmonary infection in 2, urinary tract infection in 2, and stree ulcer in 1; they were cured after medical treatment. The local complications mainly included sinus tract formation in 5, pleural tear in 2, neurologic injury in 2, intraoperative tear of inferior vena cava in 2, and the loosening of transpedicular screws in 4; they all were cured effectively.

CONCLUSION

Surgical treatment of spinal tuberculosis associated with diabetes mellitus appears to be a beneficial procedure on the condition that the blood glucose is controlled and the associated disorders and postoperative complications are properly handled, and reasonably selection of surgical procedures is very important. Instrumentation fixation provides adequate stability to allow early mobilization.