Duration of Preoperative Anti-Tuberculosis Treatment (OAT) and Clinical Outcomes Post-Surgery in Spinal TB Patients: A Systematic Review and Meta-Analysis
Keywords:
Spinal Tuberculosis, Preoperative OAT, Treatment Duration, Inflammation, Postoperative Recovery, Bone Fusion
Abstract
Spinal tuberculosis (TB) is a rare but severe infection that can lead to deformities, back pain, and neurological deficits. Preoperative administration of anti-tuberculosis drugs (OAT) is commonly used to reduce bacterial activity and inflammation before surgery. However, the optimal duration of OAT preoperatively is still debated. This study aims to systematically review and analyze the relationship between preoperative OAT duration and clinical outcomes post-surgery in patients with spinal TB. A systematic review and meta-analysis were performed on studies comparing the effects of different OAT durations preoperatively in spinal TB patients. Data were collected from PubMed, Scopus, and EMBASE. Key outcomes evaluated included Visual Analog Scale (VAS) for pain, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), wound healing, and bone fusion.
The meta-analysis showed that preoperative OAT duration of 1 to 2 weeks significantly reduced inflammation, with a notable decrease in ESR and CRP post-surgery (p = 0.006 for ESR, p = 0.02 for CRP). However, no significant differences in functional recovery or wound healing were observed between shorter (1-2 weeks) and longer (2-4 weeks) OAT durations. Bone fusion results were similar across both groups. A shorter duration of OAT preoperatively (1-2 weeks) is effective in reducing inflammation and improving postoperative recovery, though it does not significantly impact bone healing or fusion. Thus, a shorter preoperative OAT regimen can be considered a viable option in managing spinal TB patients.
References
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Memon, N. et al. (2016). Inherited disorders of bilirubin clearance. Pediatric Research, 79 (3), pp.378–386. [Online]. Available at: doi:10.1038/pr.2015.247.
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54
Ogawa, K. et al. (2022). Fracture-Separation of the Medial Humeral Epicondyle Caused by Arm Wrestling: A Systematic Review. Orthopaedic Journal of Sports Medicine, 10 (5), p.23259671221087606. [Online]. Available at: doi:10.1177/23259671221087606.
Okubo, H. et al. (2019). Epidemiology of paediatric elbow fractures: A retrospective multi-centre study of 488 fractures. Journal of Children’s Orthopaedics, 13 (5), pp.516–521. [Online]. Available at: doi:10.1302/1863-2548.13.190043.
Pabin Thapa et al. (2019). Comparison of Kirschner wires and Cannulated screw internal fixation for displaced lateral humeral condyle fracture in children. Asian Journal of Medical Sciences, 10 (6), pp.75–79. [Online]. Available at: doi:10.71152/ajms.v10i6.3486.
Pennington, R. G. C., Corner, J. A. and Brownlow, H. C. (2009). Milch’s classification of paediatric lateral condylar mass fractures: analysis of inter- and intraobserver reliability and comparison with operative findings. Injury, 40 (3), pp.249–252. [Online]. Available at: doi:10.1016/j.injury.2008.08.014.
Pribaz, J. R. et al. (2012). Lateral spurring (overgrowth) after pediatric lateral condyle fractures. Journal of Pediatric Orthopedics, 32 (5), pp.456–460. [Online]. Available at: doi:10.1097/BPO.0b013e318259ff63.
Prusick, V. W. and Muchow, R. (2023). Open Reduction and Pinning of Lateral Condyle Fractures. Journal of the Pediatric Orthopaedic Society of North America, 5 (1), p.632. [Online]. Available at: doi:10.55275/JPOSNA-2023-632.
Qi, Y. et al. (2021). Clinical value of MRI in evaluating and diagnosing of humeral lateral condyle fracture in children. Journal of Orthopaedic Surgery and Research, 16 (1), p.617. [Online]. Available at: doi:10.1186/s13018-021-02726-6.
Ranjan, R. et al. (2018). Management of Neglected Lateral Condyle Fracture of Humerus: A Comparison between Two Modalities of Fixation. Indian Journal of Orthopaedics, 52 (4), pp.423–429. [Online]. Available at: doi:10.4103/ortho.IJOrtho_319_16.
Saeed, W. and Waseem, M. (2024). Elbow Fractures Overview. In: StatPearls. Treasure Island (FL): StatPearls Publishing. [Online]. Available at: http://www.ncbi.nlm.nih.gov/books/NBK441976/ [Accessed 9 December 2024].
Sahu, R. L. (2018). Percutaneous K wire fixation in pediatric lateral condylar fractures of humerus: A prospective study. Revista Espan?ola de Cirugi?a Ortope?dica y Traumatologi?a (English Edition), 62 (1), pp.1–7. [Online]. Available at: doi:10.1016/j.recote.2017.11.001.
Shabtai, L. et al. (2020). Incidence, risk factors and outcomes of avascular necrosis occurring after humeral lateral condyle fractures. Journal of Pediatric Orthopedics. Part B, 29 (2), pp.145–148. [Online]. Available at: doi:10.1097/BPB.0000000000000698.
55
Shaerf, D. A., Vanhegan, I. S. and Dattani, R. (2018). Diagnosis, management and complications of distal humerus lateral condyle fractures in children. Shoulder & Elbow, 10 (2), pp.114–120. [Online]. Available at: doi:10.1177/1758573217701107.
Stein, B. E. et al. (2017). Cannulated Lag Screw Fixation of Displaced Lateral Humeral Condyle Fractures Is Associated With Lower Rates of Open Reduction and Infection Than Pin Fixation. Journal of Pediatric Orthopaedics, 37 (1), pp.7– 13. [Online]. Available at: doi:10.1097/BPO.0000000000000579.
Su, Y., Chen, K. and Qin, J. (2019). Retrospective study of open reduction and internal fixation of lateral humeral condyle fractures with absorbable screws and absorbable sutures in children. Medicine, 98 (44), p.e17850. [Online]. Available at: doi:10.1097/MD.0000000000017850.
Su, Y. and Nan, G. (2020). Treatment of medial humeral epicondyle fractures in children using absorbable self-reinforced polylactide pins. Medicine, 99 (17), p.e19861. [Online]. Available at: doi:10.1097/MD.0000000000019861.
Tejwani, N., Phillips, D. and Goldstein, R. Y. (2011). Management of lateral humeral condylar fracture in children. The Journal of the American Academy of Orthopaedic Surgeons, 19 (6), pp.350–358. [Online]. Available at: doi:10.5435/00124635-201106000-00005.
Thomas, D. P. et al. (2001). Three Weeks of Kirschner Wire Fixation for Displaced Lateral Condylar Fractures of the Humerus in Children: Journal of Pediatric Orthopaedics, 21 (5), pp.565–569. [Online]. Available at: doi:10.1097/01241398- 200109000-00002.
Thore?n, H. et al. (1997). An epidemiological study of patterns of condylar fractures in children. British Journal of Oral and Maxillofacial Surgery, 35 (5), pp.306–311. [Online]. Available at: doi:10.1016/S0266-4356(97)90401-0.
Vergara, A. D. N. and Fretes, A. N. (2023). Comparac?a?o entre fixac?a?o de fio de Kirschner liso e de parafusos canulados em fraturas deslocadas do co?ndilo lateral do u?mero em crianc?as. Revista Brasileira de Ortopedia, 58 (01), pp.149–156. [Online]. Available at: doi:10.1055/s-0042-1757307.
Vogel, G. et al. (2007). Fixation of humeral surgical neck fracture using contoured pins versus straight pins: a mechanical study. International Orthopaedics, 31 (6), pp.811–815. [Online]. Available at: doi:10.1007/s00264-006-0266-9.
Wang, Y. et al. (2023). Kirschner wire versus external fixation in the treatment of proximal humeral fractures in older children and adolescents: a comparative study. BMC Musculoskeletal Disorders, 24 (1), p.899. [Online]. Available at: doi:10.1186/s12891-023-07037-x.
Weiss, J. M. et al. (2009). A new classification system predictive of complications in surgically treated pediatric humeral lateral condyle fractures. Journal of
56
Pediatric Orthopedics, 29 (6), pp.602–605. [Online]. Available at: doi:10.1097/BPO.0b013e3181b2842c.
Wendling-Keim, D. S. et al. (2021). Lateral Condyle Fracture of the Humerus in Children: Kirschner Wire or Screw Fixation? European Journal of Pediatric Surgery, 31 (04), pp.374–379. [Online]. Available at: doi:10.1055/s-0040-1714656.
Westacott, D. J., Jordan, R. W. and Cooke, S. J. (2012). Functional outcome following intramedullary nailing or plate and screw fixation of paediatric diaphyseal forearm fractures: A systematic review. Journal of Children’s Orthopaedics, 6 (1), pp.75–80. [Online]. Available at: doi:10.1007/s11832-011- 0379-6.
Wu, K. et al. (2016). Diagnosis and Treatment of Anterior Tibial Plateau Fracture– Dislocation: A Case Series and Literature Review. The Journal of Knee Surgery, 30 (02), pp.114–120. [Online]. Available at: doi:10.1055/s-0036-1581136.
Afaque, S. F. and Singh, A. (2020). Outcome of Cancellous screw vs K wire fixation for management of neglected lateral condyle fracture of humerus in children. National Journal of Clinical Orthopaedics, 4 (4), pp.14–17. [Online]. Available at: doi:10.33545/orthor.2020.v4.i4a.240.
Awad, N., Sabry, H. and Elhadidy, M. (2023). Epidemiological study of the pediatric mandibular condylar fractures (the outcomes of the management); Retrospective Study. Advanced Dental Journal, 5 (2), pp.340–346. [Online]. Available at: doi:10.21608/adjc.2023.200959.1277.
Birkett, N., Al-Tawil, K. and Montgomery, A. (2020a). Functional Outcomes Following Surgical Fixation of Paediatric Lateral Condyle Fractures of the Elbow – A Systematic Review. Orthopedic Research and Reviews, Volume 12, pp.45–52. [Online]. Available at: doi:10.2147/ORR.S215742.
Birkett, N., Al-Tawil, K. and Montgomery, A. (2020b). Functional Outcomes Following Surgical Fixation of Paediatric Lateral Condyle Fractures of the Elbow - A Systematic Review. Orthopedic Research and Reviews, 12, pp.45–52. [Online]. Available at: doi:10.2147/ORR.S215742.
Cho, Y. J., Kang, S. H. and Kang, M. H. (2023). K-wire versus screws in the fixation of lateral condyle fracture of humerus in pediatrics: a systematic review and meta- analysis. BMC Musculoskeletal Disorders, 24 (1), p.649. [Online]. Available at: doi:10.1186/s12891-023-06780-5.
Cummings, J. L. et al. (2023). K-wire Versus Screw Fixation in Displaced Lateral Condyle Fractures of the Humerus in Children: A Multicenter Study of 762 Fractures. Journal of Pediatric Orthopedics, 43 (4), pp.e284–e289. [Online]. Available at: doi:10.1097/BPO.0000000000002348.
Ganeshalingam, R. et al. (2018). Lateral condylar fractures of the humerus in children: does the type of fixation matter? The Bone & Joint Journal, 100-B (3), pp.387–395. [Online]. Available at: doi:10.1302/0301-620X.100B3.BJJ-2017- 0814.R1.
Gilbert, S. R. et al. (2016). Screw versus pin fixation with open reduction of pediatric lateral condyle fractures. Journal of Pediatric Orthopaedics B, 25 (2), pp.148–152. [Online]. Available at: doi:10.1097/BPB.0000000000000238.
Jung, H.-G. et al. (2021). Comparison between Pin Fixation and Combined Screw Fixation in Proximal Chevron Metatarsal Osteotomy for Hallux Valgus Deformity
53
Correction. Clinics in Orthopedic Surgery, 13 (1), pp.110–116. [Online]. Available at: doi:10.4055/cios20003.
Justus, C. et al. (2017). Closed and Open Reduction of Displaced Pediatric Lateral Condyle Humeral Fractures, a Study of Short-Term Complications and Postoperative Protocols. The Iowa Orthopaedic Journal, 37, pp.163–169.
Kamath, A. T., Roy, S. and Pai, D. (2023). Paediatric condylar trauma – primary management considerations – A review. Journal of Oral Biology and Craniofacial Research, 13 (2), pp.236–242. [Online]. Available at: doi:10.1016/j.jobcr.2023.01.011.
Koo, K. O. T., Tan, D. M. K. and Chong, A. K. S. (2013). Distal Radius Fractures: An Epidemiological Review. Orthopaedic Surgery, 5 (3), pp.209–213. [Online]. Available at: doi:10.1111/os.12045.
Li, J. et al. (2020). Biodegradable pins for lateral condylar fracture of the humerus with an early delayed presentation in children: a retrospective study of biodegradable pin vs. Kirschner wire. BMC musculoskeletal disorders, 21 (1), p.735. [Online]. Available at: doi:10.1186/s12891-020-03774-5.
Li, W. C. and Xu, R. J. (2012). Comparison of Kirschner wires and AO cannulated screw internal fixation for displaced lateral humeral condyle fracture in children. International Orthopaedics, 36 (6), pp.1261–1266. [Online]. Available at: doi:10.1007/s00264-011-1452-y.
Lindsay, S. E. et al. (2022). The Pin: An Orthopaedic Transformation. Journal of the Pediatric Orthopaedic Society of North America, 4 (2), p.448. [Online]. Available at: doi:10.55275/JPOSNA-2022-0039.
Marcheix, P.-S. et al. (2011). Distal humerus lateral condyle fracture in children: when is the conservative treatment a valid option? Orthopaedics & traumatology, surgery & research: OTSR, 97 (3), pp.304–307. [Online]. Available at: doi:10.1016/j.otsr.2010.10.007.
Martins, T., Tiwari, V. and Marappa-Ganeshan, R. (2024). Pediatric Lateral Humeral Condyle Fractures. In: StatPearls. Treasure Island (FL): StatPearls Publishing. [Online]. Available at: http://www.ncbi.nlm.nih.gov/books/NBK560664/ [Accessed 9 December 2024].
Matijasich, P. et al. (2023). Pediatric Medial Condyle of Humerus Fracture Dislocation: A Case Report. Cureus. [Online]. Available at: doi:10.7759/cureus.43942 [Accessed 9 December 2024].
Memon, N. et al. (2016). Inherited disorders of bilirubin clearance. Pediatric Research, 79 (3), pp.378–386. [Online]. Available at: doi:10.1038/pr.2015.247.
Miller, M. D. and Thompson, S. R. (2023). Miller’s Review of Orthopaedics, 8th Edition, 1 1. 1st ed. United Kingdom: Elsevier.
54
Ogawa, K. et al. (2022). Fracture-Separation of the Medial Humeral Epicondyle Caused by Arm Wrestling: A Systematic Review. Orthopaedic Journal of Sports Medicine, 10 (5), p.23259671221087606. [Online]. Available at: doi:10.1177/23259671221087606.
Okubo, H. et al. (2019). Epidemiology of paediatric elbow fractures: A retrospective multi-centre study of 488 fractures. Journal of Children’s Orthopaedics, 13 (5), pp.516–521. [Online]. Available at: doi:10.1302/1863-2548.13.190043.
Pabin Thapa et al. (2019). Comparison of Kirschner wires and Cannulated screw internal fixation for displaced lateral humeral condyle fracture in children. Asian Journal of Medical Sciences, 10 (6), pp.75–79. [Online]. Available at: doi:10.71152/ajms.v10i6.3486.
Pennington, R. G. C., Corner, J. A. and Brownlow, H. C. (2009). Milch’s classification of paediatric lateral condylar mass fractures: analysis of inter- and intraobserver reliability and comparison with operative findings. Injury, 40 (3), pp.249–252. [Online]. Available at: doi:10.1016/j.injury.2008.08.014.
Pribaz, J. R. et al. (2012). Lateral spurring (overgrowth) after pediatric lateral condyle fractures. Journal of Pediatric Orthopedics, 32 (5), pp.456–460. [Online]. Available at: doi:10.1097/BPO.0b013e318259ff63.
Prusick, V. W. and Muchow, R. (2023). Open Reduction and Pinning of Lateral Condyle Fractures. Journal of the Pediatric Orthopaedic Society of North America, 5 (1), p.632. [Online]. Available at: doi:10.55275/JPOSNA-2023-632.
Qi, Y. et al. (2021). Clinical value of MRI in evaluating and diagnosing of humeral lateral condyle fracture in children. Journal of Orthopaedic Surgery and Research, 16 (1), p.617. [Online]. Available at: doi:10.1186/s13018-021-02726-6.
Ranjan, R. et al. (2018). Management of Neglected Lateral Condyle Fracture of Humerus: A Comparison between Two Modalities of Fixation. Indian Journal of Orthopaedics, 52 (4), pp.423–429. [Online]. Available at: doi:10.4103/ortho.IJOrtho_319_16.
Saeed, W. and Waseem, M. (2024). Elbow Fractures Overview. In: StatPearls. Treasure Island (FL): StatPearls Publishing. [Online]. Available at: http://www.ncbi.nlm.nih.gov/books/NBK441976/ [Accessed 9 December 2024].
Sahu, R. L. (2018). Percutaneous K wire fixation in pediatric lateral condylar fractures of humerus: A prospective study. Revista Espan?ola de Cirugi?a Ortope?dica y Traumatologi?a (English Edition), 62 (1), pp.1–7. [Online]. Available at: doi:10.1016/j.recote.2017.11.001.
Shabtai, L. et al. (2020). Incidence, risk factors and outcomes of avascular necrosis occurring after humeral lateral condyle fractures. Journal of Pediatric Orthopedics. Part B, 29 (2), pp.145–148. [Online]. Available at: doi:10.1097/BPB.0000000000000698.
55
Shaerf, D. A., Vanhegan, I. S. and Dattani, R. (2018). Diagnosis, management and complications of distal humerus lateral condyle fractures in children. Shoulder & Elbow, 10 (2), pp.114–120. [Online]. Available at: doi:10.1177/1758573217701107.
Stein, B. E. et al. (2017). Cannulated Lag Screw Fixation of Displaced Lateral Humeral Condyle Fractures Is Associated With Lower Rates of Open Reduction and Infection Than Pin Fixation. Journal of Pediatric Orthopaedics, 37 (1), pp.7– 13. [Online]. Available at: doi:10.1097/BPO.0000000000000579.
Su, Y., Chen, K. and Qin, J. (2019). Retrospective study of open reduction and internal fixation of lateral humeral condyle fractures with absorbable screws and absorbable sutures in children. Medicine, 98 (44), p.e17850. [Online]. Available at: doi:10.1097/MD.0000000000017850.
Su, Y. and Nan, G. (2020). Treatment of medial humeral epicondyle fractures in children using absorbable self-reinforced polylactide pins. Medicine, 99 (17), p.e19861. [Online]. Available at: doi:10.1097/MD.0000000000019861.
Tejwani, N., Phillips, D. and Goldstein, R. Y. (2011). Management of lateral humeral condylar fracture in children. The Journal of the American Academy of Orthopaedic Surgeons, 19 (6), pp.350–358. [Online]. Available at: doi:10.5435/00124635-201106000-00005.
Thomas, D. P. et al. (2001). Three Weeks of Kirschner Wire Fixation for Displaced Lateral Condylar Fractures of the Humerus in Children: Journal of Pediatric Orthopaedics, 21 (5), pp.565–569. [Online]. Available at: doi:10.1097/01241398- 200109000-00002.
Thore?n, H. et al. (1997). An epidemiological study of patterns of condylar fractures in children. British Journal of Oral and Maxillofacial Surgery, 35 (5), pp.306–311. [Online]. Available at: doi:10.1016/S0266-4356(97)90401-0.
Vergara, A. D. N. and Fretes, A. N. (2023). Comparac?a?o entre fixac?a?o de fio de Kirschner liso e de parafusos canulados em fraturas deslocadas do co?ndilo lateral do u?mero em crianc?as. Revista Brasileira de Ortopedia, 58 (01), pp.149–156. [Online]. Available at: doi:10.1055/s-0042-1757307.
Vogel, G. et al. (2007). Fixation of humeral surgical neck fracture using contoured pins versus straight pins: a mechanical study. International Orthopaedics, 31 (6), pp.811–815. [Online]. Available at: doi:10.1007/s00264-006-0266-9.
Wang, Y. et al. (2023). Kirschner wire versus external fixation in the treatment of proximal humeral fractures in older children and adolescents: a comparative study. BMC Musculoskeletal Disorders, 24 (1), p.899. [Online]. Available at: doi:10.1186/s12891-023-07037-x.
Weiss, J. M. et al. (2009). A new classification system predictive of complications in surgically treated pediatric humeral lateral condyle fractures. Journal of
56
Pediatric Orthopedics, 29 (6), pp.602–605. [Online]. Available at: doi:10.1097/BPO.0b013e3181b2842c.
Wendling-Keim, D. S. et al. (2021). Lateral Condyle Fracture of the Humerus in Children: Kirschner Wire or Screw Fixation? European Journal of Pediatric Surgery, 31 (04), pp.374–379. [Online]. Available at: doi:10.1055/s-0040-1714656.
Westacott, D. J., Jordan, R. W. and Cooke, S. J. (2012). Functional outcome following intramedullary nailing or plate and screw fixation of paediatric diaphyseal forearm fractures: A systematic review. Journal of Children’s Orthopaedics, 6 (1), pp.75–80. [Online]. Available at: doi:10.1007/s11832-011- 0379-6.
Wu, K. et al. (2016). Diagnosis and Treatment of Anterior Tibial Plateau Fracture– Dislocation: A Case Series and Literature Review. The Journal of Knee Surgery, 30 (02), pp.114–120. [Online]. Available at: doi:10.1055/s-0036-1581136.
Published
2025-04-30
How to Cite
Gusnur Gazali Ashari, Benny, & Iman Dwi Winanto. (2025). Duration of Preoperative Anti-Tuberculosis Treatment (OAT) and Clinical Outcomes Post-Surgery in Spinal TB Patients: A Systematic Review and Meta-Analysis. International Journal of Health, Economics, and Social Sciences (IJHESS), 7(2), 830~835. https://doi.org/10.56338/ijhess.v7i2.7352
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