Effect of Preoperative Anti Tuberculosis Drug Administration Duration on Tuberculous Spondylitis Surgical Treatment Outcomes

Preodita Agradi, Nucki Nursjamsi Hidajat, Ahmad Ramdan

Abstract


Preoperative anti-tuberculosis (TB) drugs play a role in surgery of TB spondylitis patients to prevent transmission in the operating room, reduce inflammatory processes and prevent relapse. Currently, there is no study on effects of preoperative anti TB drugs administration duration on the spinal TB patients surgical outcome at Dr. Hasan Sadikin Hospital (RSHS). This study used retrospective method by analyzing medical record data of TB spondylitis patients operated at RSHS, January 2014–May 2018. Based on the preoperative TB drugs duration, patients were divided into 2 groups: preoperative TB drugs group <2 and 2–4 weeks. Data analyzed were identity, duration of preoperative TB drugs administration, preoperative neurologic grade, preoperative CRP and ESR level, and postoperative data at 2 month follow up consisted of neurologic grade, postoperative CRP and ESR levels. The 58 patients consisted of 25 males and 33 females, Kolmogorov-Smirnov test showed a significant difference (p<0.05) in postoperative neurologic grade between preoperative TB drugs administration <2 vs 2-4 weeks. Unpaired T-Test showed postoperative CRP and ESR levels were significant (p<0.05). Postoperative neurologic grade in the preoperative TB drugs <2 weeks group was better vs the 2–4 week group. Operative procedure is more important in TB spondylitis patients treatment compared to a prolonged preoperative TB drugs administration.

 

Pengaruh Lama Pemberian Obat Anti Tuberkulosis Preoperatif Terhadap Hasil Pengobatan Spondilitis Tuberkulosis yang Mengalami Tindakan Operatif

Obat anti tuberkulosis (OAT) preoperatif memiliki peranan penting dalam pembedahan pasien spondilitis tuberkulosis sebagai pencegahan penularan di kamar operasi, menurunkan proses inflamasi, dan mencegah relaps. Sampai saat ini belum terdapat penelitian mengenai pengaruh lama pemberian OAT preoperatif terhadap hasil pembedahan pasien spondilitis tuberkulosis di Rumah Sakit Dr. Hasan Sadikin Bandung (RSHS). Penelitian ini menggunakan metode retrospektif dengan menganalisisa data rekam medis pasien spondilitis tuberkulosis yang dioperasi di RSHS periode Januari 2014–Mei 2018. Berdasar atas lama pemberian OAT preoperatif, sampel dibagi menjadi 2 kelompok, yaitu kelompok pemberian OAT preoperatif <2 dan 2–4 minggu. Data yang dianalisis berupa identitas, lama pemberian OAT preoperatif, tingkat neurologis preoperatif, kadar CRP dan LED preoperatif, dan data post-operatif saat follow up 2 bulan berupa tingkat neurologis, kadar CRP, dan kadar LED. Terdapat 58 pasien terdiri 25 laki-laki dan 33 perempuan, uji Kolmogorov-Smirnov menunjukkan bahwa terdapat perbedaan yang signifikan (p<0,05) pada tingkat neurologis post-operatif antara kelompok OAT <2 vs. 2–4 minggu. Uji-t tidak berpasangan memperlihatkan bahwa kadar CRP dan LED post-operatif ditemukan bermakna secara signifikan (p<0,05). Tingkat neurologis postoperatif pada kelompok pemberian OAT preoperatif <2 minggu lebih baik bila dibandingkan dengan kelompok 2–4 minggu. Tindakan operasi lebih berperan penting terhadap hasil pengobatan pasien spondilitis tuberkulosis jika dibanding dengan lama pemberian OAT preoperatif.


Keywords


C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), preoperative TB drugs

Full Text:

PDF

References


References

Tang M, Zhang H, Wang Y, Guo C, Liu J. Treatment of spinal tuberculosis by debridement, interbody fusion and internal fixation via posterior approach only. Orthop Surg. 2016;8(1):89–93.

Tiksnadi B, Herman H. The NRAMP1 polymorphism as a risk factor for tuberculous spondylitis. Malay Orthopaedic J. 2013;7(1):25–9.

Ramdan A, Setiabudiawan B, Tiksnadi B. Plasma vitamin D level and vitamin D receptor genetic polymorphism of spinal tuberculosis susceptibility in West Java population, Indonesia: does it correlated. Global J Res Analys. 2017;6(2):68–9.

Ren HL, Jiang JM, Wang JX, Qu DB, Chen JT. Is duration of preoperative anti-tuberculosis treatment a risk factor for postoperative relapse or non-healing of spinal tuberculosis?. Euro Spine J. 2016; 25(12):3875–83.

Yang L, Liu Z. Analysis and therapeutic schedule of the postoperative recurrence of bone tuberculosis. J Orthopaedic Surg Res. 2013;8:47.

Zhang P, Shen Y, Ding WY, Zhang W, Shang Z. The role of surgical timing in the treatment of thoracic and lumbar spinal tuberculosis. Archiv Orthopaedic Trauma Surg. 2014;134(2):167–72.

Rajasekaran S, Khandelwal G. Drug therapy in spinal tuberculosis. Euro Spine J. 2013;22(Suppl 4):587–93.

Wang H, Li C, Wang J, Zhang Z, Zhou Y. Characteristics of patients with spinal tuberculosis: seven-year experience of a teaching hospital in Southwest China. Intern orthopaedics. 2012;36(7):1429–34.

Sharma A, Chhabra HS, Chabra T, Mahajan R, Batra S, Sangondimath G. Demographics of tuberculosis of spine and factors affecting neurological improvement in patients suffering from tuberculosis of spine: a retrospective analysis of 312 cases. Spinal Cord. 2017;55(1):59–63.

Wang Z, Wu Q, Geng G. Anterior debridement and bone grafting with posterior single-segment internal fixation for the treatment of mono-segmental spinal tuberculosis. Injury. 2013;44(2):253–7.

Wang X, Pang X, Wu P, Luo C, Shen X. One-stage anterior debridement, bone grafting and posterior instrumentation vs. single posterior debridement, bone grafting, and instrumentation for the treatment of thoracic and lumbar spinal tuberculosis. Euro Spine J. 2014;23(4):830–7.

Loembe PM, Mwanyombet-Ompounga L, Assengone-Zeh Y, Kengue-Lechiombeka PR. Early anterolateral surgery for tuberculosis of the lower cervical spine with neurological complications in adult. Our experience in Gabon. Neuro-Chirurgie. 2000;46(6):541–8.

Sudprasert W, Piyapromdee U, Lewsirirat S. Neurological recovery determined by c-reactive protein, erythrocyte sedimentation rate and two different posterior decompressive surgical procedures: a retrospective clinical study of patients with spinal tuberculosis. J Med Associat Thai. 2015;98(10):993–1000.

Guo LX, Ma YZ, Li HW, Xue HB, Peng W, Luo XB. Variety of ESR and C-reactive protein levels during perioperative period in spinal TB. Zhongguo Gu Shang. 2010;23(3):200–2.

An HS, Seldomridge JA. Spinal infections: diagnostic tests and imaging studies (1976-2007). Clin Orthopaedics Related Res. 2006;444:27–33.

Cheung WY, Luk KDK. Pyogenic spondylitis. Intern Orthopaedics. 2012;36(2):397–404.

Jain AK. Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg. 2010;92(7):905–13.

Jain R, Sawhney S, Berry M. Computed tomography of vertebral tuberculosis: patterns of bone destruction. Clin Radiol 1993;47(3):196–9.

Ge Z, Wang Z, Wei M. Measurement of the concentration of three antituberculosis drugs in the focus of spinal tuberculosis. Euro Spine J. 2008;17(11):1482–7.




DOI: https://doi.org/10.15851/jap.v8n1.1964



 

This Journal indexed by

                               


 
Creative Commons License
JAP is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

 



View My Stats