Basic principles and conservative therapy
The success of combating bone and joint tuberculosis is based on three main principles: comprehensiveness (a strict combination of conservative methods and surgery), duration of the course, and strict specialization (treatment is carried out only in specialized inpatient facilities).
The conservative stage necessarily includes a robust supportive foundation. The patient is prescribed a rational diet with a high content of easily digestible proteins, vitamin complexes, and vital trace elements. In parallel, climatotherapy is actively used, which creates an optimal physiological background for the recovery of the body and the functioning of the immune system.
Antibacterial treatment
Medical therapy is the foundation for suppressing the infectious process. It involves the long-term use of specialized targeted chemical antibacterial agents and potent antituberculous antibiotics.
Standard treatment regimens necessarily include:
- Rifampicin
- Cycloserine
- Kanamycin
These drugs effectively halt the reproduction of mycobacteria and prevent further destruction of bone and cartilage structures.
Orthopedic regimen and immobilization
Creating absolute rest for the affected organ is a crucial task addressed from the very beginning of the treatment process.
The main goal of the orthopedic regimen is to prevent severe bone deformation and create the most favorable conditions for the healing process. Various immobilization tools are used for fixation:
- Special splints and braces.
- Custom corsets.
- Plaster casts (including plaster beds).
Strict immobilization is continued until the clinical process completely subsides, and only after that is the patient cautiously allowed to get up. Notably, in tuberculous spondylitis (spinal involvement), patients are strongly advised to wear a supportive corset for several years even after complete mobilization.
Radical surgical treatment
Surgical methods occupy a vital place in the complex management of tuberculosis when conservative measures are insufficient. The foundation consists of radical operations aimed at directly removing the source of infection:
- Necrectomy — thorough removal of specific tuberculous foci from the vertebral bodies or bone epiphyses (especially when located near joints).
- Bone resection — surgical removal of the destroyed articular end of the bone.
Special surgical approaches are required to perform these interventions. For instance, costotransversectomy is used for full access to the bodies of affected thoracic vertebrae. This method involves step-by-step resection of a rib fragment and the transverse process, allowing the surgeon to safely expose the vertebral body and the lesion itself.
Auxiliary and reconstructive surgeries
In addition to the radical removal of lesions, therapeutic and auxiliary interventions are widely used:
- Arthrodesis — surgical creation of complete immobility in a destroyed joint.
- Spinal fusion — fixation of the spine in tuberculous spondylitis using autogenous bone grafts or metal structures.
- Laminectomy — a decompressive operation used in cases of dangerous spinal cord compression.
Once the active inflammatory process is completely eliminated, the stage of corrective and reconstructive surgeries begins. Their key goal is to restore the lost functions of the affected limb, joint, or spinal segment. Such interventions include various osteotomies and joint trepanation.
Briefly: answers to topical questions
What drugs are used for etiotropic antibacterial therapy of bone and joint tuberculosis?
Targeted chemical antibacterial agents and antituberculous antibiotics are used for etiotropic antibacterial therapy. Sources list: isoniazid, rifampicin, pyrazinamide, ethambutol, streptomycin, cycloserine, kanamycin, prothionamide, aminosalicylic acid, rifabutin, levofloxacin, ciprofloxacin, and amikacin.
What types of corrective and reconstructive surgeries are performed after the elimination of the active tuberculous process?
After the elimination of the inflammatory process, corrective and reconstructive surgeries are performed to restore the functions of the limb, joint, or spine. The types specified in the source include osteotomies and joint trepanation.
What are the clinical and radiological stages (phases) of bone and joint tuberculosis?
The course of bone and joint tuberculosis is divided into the following clinical and radiological phases:
- Pre-spondylitic phase — characterized by signs of primary osteitis (a limited cavity in the vertebral body or destruction of bone trabeculae).
- Spondylitic phase — accompanied by destruction of vertebral bodies, pain, restricted movement, and spinal deformity. It includes the subsidence stage, when pain decreases and myogenic contracture becomes less pronounced.
- Post-spondylitic phase — a period of relative well-being with subsidence of inflammatory phenomena, although severe deformations, cold abscesses, fistulas, and neurological disorders may persist.
What specific complications, besides spinal cord compression, are characteristic of tuberculous spondylitis?
In addition to spinal cord compression, patients with tuberculous spondylitis may develop cold abscesses, purulent fistulas, and neurological disorders. Furthermore, severe spinal deformities and secondary chest deformations may persist throughout the course of the disease.
To memorize the main antibiotics, use the abbreviation RCK: Rifampicin, Cycloserine, Kanamycin.
Class and exam questions
What is costotransversectomy?
This is a surgical approach to the bodies of the thoracic vertebrae, in which a rib and transverse process are resected to directly expose the lesion.
When can corrective reconstructive surgeries be performed?
Reconstructive surgical interventions (osteotomies, trepanations) are performed only after the complete and stable elimination of the inflammatory process.
How long do you need to wear a corset for tuberculous spondylitis?
After the process subsides and the patient is mobilized, wearing a supportive corset is recommended to continue for several years.
What else to study on this topic
- Mechanism of action and side effects of rifampicin and cycloserine
- Surgical technique and types of bone grafts for spinal fusion
- Indications and contraindications for laminectomy
- Features of surgical debridement of a tuberculous lesion in the lumbar vertebrae
- Biomechanics of joints after arthrodesis surgery
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