title: Management of drug-resistant spinal tuberculosis with a combination of surgery and individualised chemotherapy: a retrospective analysis of thirty-five patients.
abstract: OBJECTIVE
  Drug-resistant tuberculosis is a major public-health concern globally and can be difficult to manage clinically. Spinal tuberculosis is the most common manifestation of extrapulmonary tuberculosis. However, there have been few reports on the topic of drug-resistant spinal tuberculosis. The aim of this study was to investigate the clinical characteristics and drug susceptibility patterns and the outcomes of management with a combination of surgery and individualised chemotherapy, for drug-resistant spinal tuberculosis.
  
  
  METHODS
  We retrospectively analysed 35 patients with drug-resistant tuberculous spondylitis. After surgery, individualised chemotherapy was tailored for each patient according to the drug-resistance profile and previous history of chemotherapy. The patients were followed up clinically and radiologically for an average period of 35.8 months.
  
  
  RESULTS
  Among 35 drug-resistant spinal tuberculosis cases, 13 were retreatment cases. Twelve were multi-drug resistant tuberculosis (MDR-TB), and 23 were non-MDR-TB. The patients with MDR-TB and non-MDR-TB had undergone previous chemotherapy for an average of 14.50 ± 2.00 (0-60) months and 4.56 ± 1.54 (0-74) months, respectively. A total of 32 cases underwent open operations, and the other three had percutaneous drainage and local chemotherapy. Patients received individualised chemotherapy for an average of 23.6 months postoperatively. Local recurrence was observed in six patients. Thirty-three patients had been cured at the final follow-up, and the other two were still receiving chemotherapy.
  
  
  CONCLUSIONS
  Drug-resistant tuberculous spondylitis is mainly acquired through previous irregular chemotherapy and the spreading of drug-resistant strains. Management with a combination of surgery and individualised chemotherapy is feasible in the treatment of severe complications and the prevention of acquired drug resistance.
authors: Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China. lltop_1@sina.com
authors: Litao
authors: L
authors: Li
authors: Zehua
authors: Z
authors: Zhang
authors: Fei
authors: F
authors: Luo
authors: Jianzhong
authors: J
authors: Xu
authors: Peng
authors: P
authors: Cheng
authors: Zheng
authors: Z
authors: Wu
authors: Qiang
authors: Q
authors: Zhou
authors: Qingyi
authors: Q
authors: He
authors: Fei
authors: F
authors: Dai
authors: Jian
authors: J
authors: Wang
authors: Jinsong
authors: J
authors: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010027:Osteotomy; D012189:Retrospective Studies; D013123:Spinal Fusion; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000601:surgery*; D014399:Tuberculosis, Spinal / Q000188:drug therapy* / Q000601:surgery*; D055815:Young Adult