Does spinal surgery for spinal tuberculosis during active infection predispose to post operative surgical site infection?: Experience From Kenyatta national hospital

Abstract

Background: Spinal Tuberculosis (TB) is the most common form of skeletal TB. Its incidence has seen an increase over the past 3 decades due to the AIDS epidemic. Absolute non-operative treatment was offered in pre antibiotic era. Surgery has become an integral component in the management of spinal TB in current practice. The rate of SSI varies from 2% to 20% for all surgical spinal procedures.
Objective: Does spinal surgery for spinal tuberculosis during active infection predispose to post operative Surgical Site Infection (SSI). The aim of this study was to note the incidence of infection in patients undergoing spinal surgery for tuberculosis.
Methods: All patients who had complete medical records and had surgery for spinal tuberculosis were recruited into the study. The study period was from 2005 to 2015. Relevant data was collected and appropriately analyzed.
Results: For all the patients, chemotherapy was started immediately after tuberculosis of the spine was diagnosed. Five patients had involvement of the lumbar region, one patient with involvement of the cervical region and the rest had involvement of the thoracic region. One patient had 3 vertebrae involved, 3 patients had one vertebrae involved and 14 patients had 2 vertebrae involved. Out of the 18 patients, 12 showed improvement after surgery, 4 patients had no difference after surgery and 2 patients worsened after surgery. Two patients showed improvement after 1 week; 3 patients after 2 weeks; 3 patients after 1 month; 4 patients after 2 months. Of the patients who worsened; 1 patient worsened by 1 grade while another worsened by 2 grades. No patient had any SSI. This was irrespective of whether they had instrumented spine surgery or not.
Conclusion: This study shows that spinal surgery for spinal tuberculosis does not lead to increased surgical site infection even in the presence of active tuberculosis infection. Addition of spinal instrumentation to the surgical strategy does not predispose to increased infection rate. Larger studies need to be carried out to validate this data.

Key words: Spinal tuberculosis, Spinal surgery, Surgical site infections