{"paper_id":"21adf35f-a4c7-4707-bdf2-6f72dd8cffa9","body_text":"Clinical Characteristics, Risk Factors, and Management Strategies of Postoperative Recurrence in Thoracolumbar Tuberculosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Clinical Characteristics, Risk Factors, and Management Strategies of Postoperative Recurrence in Thoracolumbar Tuberculosis Lichuan Liang, Chen Zhao, Lei Luo, Liehua Liu, Pei Li, Qiang Zhou This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4600215/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To investigate the clinical characteristics and identify risk factors of postoperative recurrence in thoracolumbar tuberculosis, aiming to assess clinical significance and propose management strategies. Methods Retrospective review of 69 patients' medical records with postoperative recurrence of thoracolumbar tuberculosis from 2006 to 2019, including demographics, clinical presentations, radiographic data, drug susceptibility, laboratory results, and recurrence patterns. Results The study included 40 males and 29 females, with a mean age of 36.1 ± 14.2 years at initial surgery and 37.5 ± 14.5 years at recurrence. Manifestations included pain (55.1%), sinus tracts (47.8%), and neurological deficits (37.7%). Radiographic assessments showed paravertebral (89.9%) and flowing abscesses (37.7%). Drug resistance was present in 41.5% of cases. Inflammatory markers were elevated in most patients, with anemia and hypoalbuminemia frequently observed. Most recurrences occurred within 24 months post-surgery, with a maximum interval of 84 months, and 37.7% had multiple recurrences. Conclusion Postoperative recurrence in thoracolumbar tuberculosis is multifactorial, linked to drug-resistant tuberculosis, inconsistent medication adherence, poor nutrition, inadequate immobilization, and systemic tuberculosis infections. Optimal postoperative surveillance and clinical management necessitate a focus on inflammatory markers, advanced imaging, diligent patient education, and rigorous follow-up to diminish recurrence rates and enhance patient outcomes. Health sciences/Medical research/Epidemiology Health sciences/Medical research/Outcomes research Health sciences/Medical research/Study design Health sciences/Diseases/Infectious diseases Biological sciences/Neuroscience Introduction Thoracolumbar tuberculosis, an extrapulmonary form, poses a significant health challenge. According to the World Health Organization (WHO), tuberculosis was the second leading cause of death from a single infectious agent in 2022, following COVID-19, with an estimated 10 million new infections annually [ 1 ]. This condition is particularly prevalent among adults, peaking in the 30–50 age group and showing a rising trend among the elderly [ 2 , 3 , 4 ]. Clinically, patients present with pain, reduced mobility, fatigue, and weight loss, typically starting with pain that worsens upon movement (19). The standard treatment paradigm includes a combination of anti-tuberculosis medications, surgery, and rehabilitation, with a primary focus on medical management. Diagnostic imaging reveals bone destruction, intervertebral space narrowing, and sequestration of dead bone[ 30 ]. The standard treatment paradigm encompasses a combination of anti-tuberculosis drugs, surgical intervention, and rehabilitation, prioritizing medical management. Surgical intervention is also a component of this paradigm, with surgical consideration reserved for patients with treatment failure, neurological compromise, or significant bony destruction. The surgical approaches utilized in this study included anterior, posterior, and combined anterior-posterior procedures. A comparative analysis of these different surgical methods revealed no significant differences in terms of cure rates, bone graft fusion times, spinal deformity correction, or neurological function improvement among patients postoperatively. [ 7 , 8 , 9 , 10 , 11 ] The threat of postoperative recurrence poses a significant concern for patients following surgical intervention for thoracolumbar tuberculosis. These recurrences can arise from a multitude of factors, including varied postoperative anti-tuberculosis regimens, incomplete lesion eradication, nutritional deficits, compromised immunity, and inadequate immobilization. Recurrence rates in the tuberculosis patient population hover between 2.26% and 10.3%, significantly affecting quality of life and complicating treatment strategies [ 1 , 12 , 13 , 14 ]. The recurrence rate in this study was statistically determined to be 5.2%. The clinical profile of recurrent cases may deviate from primary presentations, often leading to diagnostic delays and protracted treatment initiation due to subtle symptomatology. This study is poised to dissect the determinants of recurrence meticulously, with the goal of formulating targeted management protocols and intraoperative directives to mitigate this risk. Our study aims to conduct a comprehensive examination of the multifaceted impact of postoperative recurrence on thoracolumbar tuberculosis, covering recurrence frequency, temporal patterns, treatment modalities, and the wider impact on patient quality of life. By meticulously examining a comprehensive series of recurrent cases, we aim to delineate the clinical nuances of thoracolumbar tuberculosis recurrence, thereby providing clinicians with a more precise tool for patient management.The study's scope encompasses the translation of research findings into tangible clinical strategies, aimed at preventing postoperative recurrence and improving treatment efficacy, with the ultimate goal of enhancing patient prognoses. The underlying hypothesis of our study posits that recurrence is intricately linked to a spectrum of factors, including patient age, gender, lesion site, surgical technique, treatment duration, and the issue of tuberculosis drug resistance. A retrospective and comprehensive analysis of a robust case series is essential for testing these hypotheses and exploring the full clinical significance of postoperative recurrence. Hypothesis We hypothesize that postoperative recurrence of thoracolumbar tuberculosis is significantly associated with multiple factors, including patient age, gender, lesion location, surgical method, treatment duration, and drug-resistant tuberculosis. To test this hypothesis, we will conduct a comprehensive retrospective analysis of a sizable patient cohort to clarify the multifaceted impact of postoperative recurrence. Current Research Status In the context of recurrent spinal tuberculosis and its associated complications, including sinus tract formation, Yang L et al. [ 12 ] conducted an insightful analysis to evaluate the comparative efficacy of various treatment strategies.Their findings highlighted the necessity of promptly adjusting treatment protocols upon encountering treatment ineffectiveness. Ren HL et al. [ 13 ]emphasized the critical role of initiating treatment with a robust anti-tuberculosis drug regimen, comprising four or five drugs, for patients facing postoperative recurrence. Their findings highlighted the necessity of promptly adjusting treatment protocols when faced with treatment ineffectiveness. Additionally, the study explored the pivotal influence of patients' pre- and post-surgical nutritional and emotional well-being on treatment efficacy, and the significant role of patient education in bolstering therapeutic adherence and confidence. Biao Wang et al. [ 14 ]advocated for the advantages of a unified posterior surgical approach involving debridement, osteotomy, correction, grafting, and fusion in managing recurrent thoracolumbar spinal tuberculosis with kyphosis. Collectively, these investigations have illuminated the current therapeutic landscape and have laid the groundwork for future advancements in clinical practice and research. Limitations of Existing Research Despite the informative nature of current research, it is deficient in delineating the subtle clinical characteristics of recurrent spinal tuberculosis cases. Our study aims to address this gap through an exhaustive case-by-case analysis, with the intention of revealing the intricate clinical features of recurrence. A notable absence is present within the literature concerning a detailed comparative analysis between primary and recurrent cases, resulting in a diagnostic and treatment lag for patients with recurrence. This deficiency hinders the synthesis of research findings. Furthermore, existing research efforts concerning the factors contributing to postoperative recurrence are disjointed and devoid of a cohesive, systematic discourse. Results Basic Information of Recurrence Patients Our study included 69 patients with postoperative recurrence of thoracolumbar tuberculosis, comprising 40 males and 29 females. The age of participants at the time of initial surgery ranged from 5 to 67 years, with a mean of 36.1 ± 14.2 years. The age at recurrence ranged from 7 to 69 years, averaging 37.5 ± 14.5 years. Surgical approaches were anterior in 31 cases, posterior in 22, and a combination in 15 cases. Statistical analysis showed no significant differences in age, gender, or surgical approach among the groups with recurrence (P > 0.05). A comprehensive summary of these findings is detailed in Table 1 . Table 1 Patient Characteristics Characteristic Category Number or Mean ± SD Range P-value Gender Male/Female 40/29 - > 0.05 Age at Initial Diagnosis (years) Mean ± SD 36.1 ± 14.2 5–67 - Total Number of Patients - 69 - - Age at Recurrence (years) Mean ± SD 37.5 ± 14.5 7–69 > 0.05 Surgical Approach Anterior/Posterior Anterior: 31 - > 0.05 Posterior: 22 Combined: 15 Note: No statistically significant differences were observed for gender, age at initial diagnosis, or surgical approach (P > 0.05). Clinical Presentations of Recurrence Patients Analysis of recurrent site distribution revealed 13 cases of thoracic tuberculosis, 20 cases of thoracolumbar tuberculosis (specifically T11-L1), and the most prevalent site was lumbar tuberculosis, with 36 cases. Clinical manifestations included pain in 38 cases (55.1%), sinus tract formation in 33 (47.8%), and neurological deficits in 26 cases (37.7%). ASIA grading was Grade B in 2 cases, Grade C in 7, and Grade D in 17. Local masses were observed in 25 cases (36.2%). Additionally, 20 cases (29%) exhibited tuberculous toxic symptoms such as cough, sputum, low-grade fever, night sweats, fatigue, and weight loss. Notably, 14 cases (20.3%) presented with both sinus tracts and masses, and 9 cases (13.0%) had concurrent pain, tuberculous toxic symptoms, and neurological deficits. Concurrent systemic tuberculosis was identified in 28 patients (40.6%), including 2 cases with both pulmonary and urinary tuberculosis, and 1 case with tuberculous peritonitis. A comprehensive summary of these findings is detailed in Table 2 . Radiographic Findings Radiographic evaluations revealed paravertebral abscesses in 62 cases, representing 89.9% of the sample. Flowing abscesses were observed in 26 cases (37.7%), and kyphosis was present in 25 cases (36.2%). Complications associated with internal fixation hardware were noted in 23 cases (33.3%), including cases of screw loosening, screw breakage, titanium rod fractures, and titanium mesh collapses. A substantial proportion of cases, representing 60 (86.9%), presented with concurrent paravertebral and flowing abscesses. Furthermore, a smaller cohort of patients, encompassing 10 cases (14.5%), exhibited a triad of complications including kyphosis, unsuccessful bone graft fusion, and concurrent issues with internal fixation.A comprehensive summary of these findings is detailed in Table 2 . Table 2 Clinical and Radiographic Features of Recurrence Feature Number of Cases Percentage Recurrence Site Thoracic Tuberculosis 13 18.8% Thoracolumbar(T11-L1) 20 28.9% Lumbar Tuberculosis 36 52.2% Clinical Manifestations Pain 38 55.1% Sinus Tract Formation 33 47.8% Neurological Deficits 26 37.7% Local Mass 25 36.2% Tuberculous Toxic Symptoms 20 29.0% Combined Manifestations Sinus Tract and Mass 14 20.3% Pain, Toxic Symptoms, and Neurological Deficits 9 13.0% Concurrent Systemic Tuberculosis Pulmonary Tuberculosis 28 40.6% Pulmonary and Urinary Tuberculosis 2 2.9% Tuberculous Peritonitis 1 1.4% Radiographic Findings Paravertebral Abscess 62 89.9% Flowing Abscess 26 37.7% Kyphosis 25 36.2% Internal Fixation Complications 23 33.3% Drug Resistance Of the 69 patients with recurrent disease, Mycobacterium tuberculosis culture and drug susceptibility data were available for 53. Drug resistance was detected in 22 cases, representing 41.5% of patients with evaluable data. The resistance profile comprised monodrug resistance in 1 case, polydrug resistance in 5, and multidrug resistance (MDR) in 16 cases. Notably, MDR accounted for 72.7% of detected resistance cases. Irregular adherence to anti-tuberculosis medication was observed in 11 cases, representing 50% of the total with drug resistance data. Laboratory Tests Elevated C-reactive protein (CRP) levels were observed in 61 patients, accounting for 88.4% of the study cohort. CRP levels peaked at 71.6 mg/L, averaging 38.3 ± 18.1 mg/L, which significantly exceeds the normal threshold of less than 8 mg/L. Erythrocyte sedimentation rate (ESR) was elevated in 57 patients (82.6%), with a maximum of 100 mm/h and an average of 51.6 ± 21.4 mm/h, surpassing the normal limit of less than 20 mm/h. In addition to elevated CRP levels, anemia was diagnosed in 37 patients (53.6%), with an average hemoglobin level of 98.3 ± 15.4 g/L. Hypoalbuminemia was also observed in 20 patients (28.9%), with an average albumin level of 34.8 ± 3.1 g/L. Elevated ESR and CRP were observed in combination in 54 cases (78.3%), and hypoalbuminemia co-occurred with anemia in 17 cases (24.6%).A comprehensive summary of these findings is detailed in Table 3 . Table 3 Laboratory Findings Test Number of Cases Mean ± SD (Normal Range) Percentage Elevated C-Reactive Protein (CRP) 61 38.3 ± 18.1 mg/L (< 8 mg/L) 88.4% Increased Erythrocyte Sedimentation Rate (ESR) 57 51.6 ± 21.4 mm/h (< 20 mm/h) 82.6% Anemia 37 98.3 ± 15.4 g/L (Males < 120 g/L, Females < 110 g/L) 53.6% Hypoalbuminemia 20 34.8 ± 3.1 g/L (< 38 g/L) 28.9% Analysis of Recurrence Time Distribution and Frequency. Among the 69 patients studied, 43 (62.3%) experienced a single recurrence, while 26 (37.7%) had multiple recurrences. Of these, 20 patients had two recurrences, 5 had three, and one patient experienced four recurrences. Recurrence intervals were as follows: 10 cases within 6 months, 31 cases between 6 to 12 months, 8 cases between 12 to 18 months, 4 cases between 18 to 24 months, 3 cases between 24 to 36 months, 5 cases between 36 to 48 months, 3 cases between 48 to 60 months, and 5 cases beyond 60 months. The longest recurrence time observed was 84 months, an exceptional duration.A comprehensive summary of these findings is detailed in Table 4 . Table 4 Recurrence Timing and Frequency Category Number of Cases Percentage Recurrence Frequency Once 43 62.3% Twice 20 37.7% Thrice 5 Four times 1 Recurrence Timing Within 6 months 10 76.9% 6–12 months 31 12–18 months 8 18–24 months 4 24–36 months 3 - 36–48 months 5 - 48–60 months 3 - Beyond 60 months 5 - Longest Recurrence Time - 84 months Discussion Tuberculosis as a Systemic Disease and Recurrence Risk The primary clinical manifestations in patients with recurrent thoracolumbar tuberculosis include pain, sinus tract formation, and neurological deficits, whereas patients with primary tuberculosis predominantly present with pain, night sweats, and low-grade fever. Notably, only 55.1% of recurrent patients experience pain, a significantly lower rate than the 83–100% observed in primary patients [ 15 – 20 ] Additionally, the frequency of low-grade fever and night sweats is relatively lower in recurrent patients, which may be associated with the continuation of anti-tuberculosis medication during the recurrent phase for some patients. Particularly striking is the observation that 44.9% of recurrent patients in this study did not exhibit pain upon recurrence and also presented with fewer tuberculous toxic symptoms such as low-grade fever and night sweats. This finding suggests that the atypical clinical presentation in recurrent patients is a significant factor contributing to delayed diagnosis and treatment. Therefore, clinicians should remain vigilant about the possibility of recurrence, even in patients already undergoing anti-tuberculosis therapy. Furthermore, this study highlights the importance of long-term, regular follow-up for patients with thoracolumbar tuberculosis. Regular clinical assessments and imaging studies are crucial for the timely detection of signs of recurrence, allowing for the prompt initiation of treatment and improved patient prognosis. For patients without pain, physicians should pay closer attention to other clinical and radiological clues that may indicate recurrence. Tuberculosis, known for its systemic nature, often presents extrapulmonary, commonly involving the spine. In our region, pulmonary tuberculosis was identified in 14.4% of patients initially diagnosed with spinal tuberculosis [ 21 , 23 ]. Among patients with recurrence, a substantial 44.9% had concurrent tuberculosis in other systems, notably pulmonary (43.4%), urinary (2.9%), and tuberculous peritonitis (1.5%). Given the chronic and debilitating nature of tuberculosis, extended treatment can adversely impact liver and renal function and reduce appetite. Postoperative recurrence can exacerbate these conditions, potentially causing anemia, electrolyte imbalances, and protein depletion, thereby increasing the risk of malnutrition.Our comprehensive risk factor analysis highlights that malnourished patients are particularly susceptible to recurrence. Consequently, for tuberculosis management, emphasis is placed on a diet rich in nutrients and protein, with vigilant monitoring for anemia, hypoalbuminemia, and electrolyte levels.Symptomatic treatments, including immunomodulatory agents and blood transfusions, are often necessary in certain cases.Collectively, nutritional support is deemed as integral to treatment as anti-tuberculosis medications. Anti-tuberculosis Medication and Drug Resistance Issues Anti-tuberculosis medication forms the cornerstone of treatment for all patients with tuberculosis. The prevalence of primary and acquired drug-resistant tuberculosis is reported to be 3.4% and 25%, respectively [ 1 , 23 , 25 ]. In 2022, the average prevalence of multidrug-resistant tuberculosis among newly diagnosed cases was 3.9%, with the proportion of patients initially diagnosed with MDR/RR-TB remaining at approximately 3–4%. This figure rises to 18–21% among patients who have previously received treatment for tuberculosis [ 1 , 24 ]. Globally, the combined prevalence of multidrug-resistant tuberculosis stands at 11.6% [ 32 ]. Among the 53 patients at our institution who underwent Mycobacterium tuberculosis culture and drug susceptibility testing, drug resistance was identified in 22 cases, amounting to a 41.5% resistance rate. This rate significantly exceeds the regional spinal tuberculosis resistance rate of 6.7% and is predominantly characterized by multidrug resistance, accounting for 72.7% of all resistant cases. Drug resistance in Mycobacterium tuberculosis arises from a complex interplay of biological, clinical, and microbiological factors, rather than a single mechanism [ 23 ]. This includes suboptimal or inadequate anti-tuberculosis treatment regimens, which increase the risk of developing genetically resistant strains; the complexity of granulomatous lesions and their poor vascularization, which impede drug distribution and lead to suboptimal drug concentrations, thus fostering the development of phenotypic and genetic drug resistance; the inherent high-level antibiotic resistance of Mycobacterium tuberculosis; the presence of non-replicating (NR) bacilli within granulomas, which exhibit phenotypic drug resistance; and chromosomal mutations that result in acquired drug resistance, generating genetically resistant strains. The findings from our logistic regression analysis underscore the significant role of drug-resistant tuberculosis in the recurrence of thoracolumbar tuberculosis. It is imperative that all patients undergo mycobacterial culture and drug susceptibility testing, with an emphasis on obtaining multiple samples, such as necrotic bone tissue, soft tissue, and pus, to enhance diagnostic accuracy. Upon confirmation of drug resistance, personalized anti-tuberculosis treatment regimens should be formulated for each patient based on their specific resistance profile. Moreover, given the mechanisms of tuberculosis drug resistance, particularly the impact of suboptimal or inadequate treatment durations, it is crucial to impress upon patients the importance of adhering to a standardized and comprehensive course of anti-tuberculosis medication. Inflammatory Markers and Recurrence Diagnosis In our cohort of patients undergoing primary surgery for thoracolumbar tuberculosis, 87.6% showed normalization of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) by the first postoperative month, rising to 96.7% within three months. In contrast, Cui et al. [ 26 ]reported that both CRP and ESR returned to normal levels three months postoperatively.However, patients with recurrence exhibited significant increases in these markers, with elevated CRP in 88.4% and ESR in 82.6% of cases. Given their role as inflammatory indicators, CRP and ESR are essential for diagnosing recurrent thoracolumbar tuberculosis. Thus, postoperative surveillance for thoracolumbar tuberculosis should include CRP and ESR as routine assessments. Patients with persistently elevated marker levels three months post-surgery require more frequent laboratory and imaging evaluations.For patients whose levels of these markers do not return to normal within three months post-surgery, more frequent laboratory and imaging evaluations are warranted. Enhancing patient awareness of potential postoperative recurrence, alongside the standardization of anti-tuberculosis medication and nutritional support, can significantly reduce the likelihood of recurrence and expedite the diagnosis and management of affected patients. Role of Imaging in Recurrence Diagnosis In spinal tuberculosis, the thoracic and lumbar vertebrae are commonly affected [ 5 , 6 , 19 , 31 ]. Interestingly, our study found a higher prevalence of lumbar tuberculosis (36 cases) than thoracic (13 cases) in recurrent cases, despite thoracic tuberculosis being more common overall. This discrepancy likely results from the increased mobility and load-bearing nature of the lumbar spine. Notably, no cervical tuberculosis recurrences were observed, and logistic regression suggested a potential link between inadequate postoperative fixation and increased recurrence risk related to spinal mobility and load-bearing. Given these findings, we recommend prioritizing spinal instrumentation in thoracolumbar tuberculosis surgeries, encompassing thorough intraoperative lesion debridement, spinal stability reconstruction, and the routine use of external orthotic devices for three months postoperatively, extended as needed for complex cases. This approach could reduce the likelihood of postoperative recurrence. The use of external orthotic devices is critical for limiting spinal motion, reducing mechanical stress on surgical sites, ensuring fusion and internal fixation stability, and aiding the healing process. MRI is the preferred imaging modality for early tuberculosis lesion detection [ 27 , 30 ], surpassing X-rays and CT in diagnostic efficacy [ 28 , 29 ]. Considering the complex mechanisms of tuberculosis drug resistance, such as the barriers to drug distribution due to granulomatous lesion complexity and poor vascularization, thorough lesion debridement during surgery is essential for reducing drug resistance and recurrence risks. Our analysis indicated that a significant 76.8% of recurrences occurred within the first two postoperative years, which underscores the critical need for vigilant follow-up during this period and the indispensable role of MRI in diagnosing thoracolumbar tuberculosis, thereby enabling the early identification and prompt treatment of recurrent cases. Postoperative Recurrence Monitoring and Management Importance of Patient Education and Follow-up A notable 26 patients (37.7%) within our cohort experienced multiple recurrences. It is essential for healthcare providers to proactively inform these patients about the possibility of further recurrences and to emphasize the importance of diligent self-monitoring. Education initiatives should enable patients to identify and report any symptomatic changes indicative of recurrence. Enhanced patient awareness of these symptoms can facilitate early detection of recurrence and prompt initiation of treatment strategies. For individuals who have undergone surgery for thoracolumbar tuberculosis, the initial two-year postoperative period is critical, being the period of highest recurrence risk. It is imperative that during this timeframe, healthcare providers rigorously monitor for symptoms indicative of recurrence, focusing particularly on pain, sinus tracts, local masses, and neurological deficits. Elevated erythrocyte sedimentation rate and C-reactive protein levels persisting beyond three months post-surgery should prompt a thorough investigation into the potential for recurrence. In cases of recurrent thoracolumbar tuberculosis, a concerted effort must be made to address the challenge of drug-resistant tuberculosis. Mycobacterial culture and drug susceptibility testing are essential for all patients, enabling the formulation of personalized anti-tuberculosis treatment plans aligned with each patient's resistance profile. Conclusion Our study confirms the complex, multifactorial nature of postoperative recurrence in thoracolumbar tuberculosis and identifies several key risk factors. Through rigorous analysis, we propose a set of targeted management strategies that may significantly reduce the rate of recurrence. Our findings hold significant implications for clinical practice, particularly in enhancing post-surgical surveillance and treatment protocols for patients. The critical importance of early detection and intervention is paramount, as timely management is crucial for achieving better patient outcomes. We advocate for the adoption of our proposed strategies in clinical practice to improve patient care and reduce the disease burden. Materials and Methods Data Source and Collection Our study included individuals diagnosed with thoracolumbar tuberculosis and consecutively treated at our facility from 2006 to 2019. We provide a detailed description of the methodologies used for data collection and subsequent analysis. The inclusion criteria were as follows: (i) individuals initially diagnosed with thoracolumbar tuberculosis who underwent lesion clearance with bone graft fusion and internal fixation surgery; (ii) those with postoperative recurrence admitted for inpatient treatment at our facility, with a mandatory minimum follow-up of 5 years. Exclusion criteria included cases where patients were lost to follow-up or chose to withdraw from the study at any point in the treatment continuum, leading to the exclusion of 5 patients. In accordance with the established criteria, this study enrolled a total of 69 patients with thoracolumbar tuberculosis. Specifically, 36 patients experienced recurrence following their initial surgery at our institution, while 33 patients had recurrences after their initial surgery performed at an external facility. The study cohort comprised 40 males and 29 females. To serve as a comparative group, we selected 657 patients from the same period who did not experience recurrence, and for whom clinical presentations, radiological data, and laboratory information were available for analysis. (i) Medical Record Analysis: Using our hospital's information system, we retrieved comprehensive medical records for patients diagnosed with thoracolumbar tuberculosis. (ii) Radiographic Data Compilation: We compiled imaging data, including X-rays, CT scans, MRI reports, and other pertinent radiographic records. (iii) Laboratory Parameter Collection: We systematically collected a wide range of laboratory data, encompassing complete blood counts, hepatic and renal function tests, erythrocyte sedimentation rates (ESR), C-reactive protein (CRP) levels, and other pertinent biochemical indices. (ⅳ) Clinical Presentation Documentation: Clinical manifestations were meticulously documented through a thorough review of medical records. This included noting the presence of local masses, sinus tracts, grading pain intensity, and assessing functional limitations. (ⅴ) Recurrence Phenomenon Tabulation: A detailed tabulation of recurrence events was executed, recording the frequency of recurrences, specific timings, and collating associated data points such as the nature of surgical interventions, postoperative care regimens, and the nutritional status of patients at the time of recurrence. Application of Quantitative Analysis Methods This study leveraged a suite of quantitative analysis techniques to perform an in-depth statistical inquiry into the amassed data. The overarching goal was to delineate the clinical hallmarks of postoperative recurrence in patients with thoracolumbar tuberculosis. Our analytical framework encompassed both descriptive and regression analyses, utilizing SPSS 25.0 as the statistical engine. Ethics . This study adheres to all relevant ethical guidelines and regulatory standards. The research protocols were reviewed and approved by the Ethics Committee of the Third Affiliated Hospital of Chongqing Medical University. Prior to their participation, informed consent was obtained from all participants involved in the study. (ⅰ) Statistical Analysis The initial foray into our data set involved a descriptive statistical analysis, aimed at encapsulating the foundational characteristics of our patient cohort, including but not limited to age, gender, and disease trajectory. This approach allowed us to distill the demographic essence of the study population. For the subset of patients experiencing postoperative recurrence, key metrics such as recurrence rate, timing, and frequency were also analyzed descriptively. Graphical tools were employed to render the data distribution, providing a visual scaffold for grasping the overarching trends and patterns inherent in postoperative recurrence.See Table 5 for details. Table 5 Chi-Square Analysis of Potential Recurrence Factors Factor Chi-Square Value Degrees of Freedom P-value Gender (Male = 0, Female = 1) 1.011 1 .315 Age 61.072 75 .877 Presence of Pulmonary Tuberculosis 17.482 1 .000 Irregular Anti-Tuberculosis Medication Use 18.030 1 .000 Drug Resistance Status (Resistant = 0, Susceptible = 1) 11.981 1 .001 Poor Nutritional Status (Yes = 0, No = 1) 11.624 1 .001 Single Vertebral Segment Involvement (Yes = 0, No = 1) 0.043 1 .835 Strictness of Postoperative Immobilization (Yes = 0, No = 1) 9.910 1 .002 Note: P-values less than 0.05 were considered to indicate statistical significance. (ⅱ) Regression Analysis In a bid to unearth the determinants of postoperative recurrence, a battery of variables hypothesized to be linked to recurrence were subjected to regression analysis. Postoperative recurrence served as the dependent variable, while a spectrum of factors including age, gender, concomitant pulmonary tuberculosis, drug-resistant tuberculosis status, history of erratic anti-tuberculosis medication adherence, single-segment involvement, stringent postoperative immobilization, and nutritional integrity were considered as independent variables. A multivariate logistic regression model was engaged to probe the interrelation between these factors and the likelihood of postoperative recurrence. Notably, the study evaluated the candidacy of drug-resistant tuberculosis, nutritional status, and the rigor of postoperative immobilization as independent risk factors through logistic regression. To fortify the predictive validity of the model, a ROC (Receiver Operating Characteristic) curve analysis was integrated, offering a metric of accuracy and discriminatory power.See Table 6 for details. Table 6 Multivariate Logistic Regression Analysis of Recurrence Factors Factor Beta Coefficient Standard Error Odds Ratio 95% Confidence Interval P-value Gender (Male = 0, Female = 1) 0.212 0.300 1.236 0.687 to 2.225 .480 Presence of Pulmonary Tuberculosis 1.475 0.336 4.370 2.264 to 8.439 .000 Irregular Anti-Tuberculosis Medication Use 2.115 0.528 8.288 2.947 to 23.312 .000 Drug Resistance Status (Resistant = 0, Susceptible = 1) 1.565 0.369 4.783 2.322 to 9.850 .000 Poor Nutritional Status (Yes = 0, No = 1) 1.623 0.382 5.071 2.398 to 10.720 .000 Single Vertebral Segment Involvement (Yes = 0, No = 1) 0.165 0.343 1.179 0.602 to 2.308 .631 Strictness of Postoperative Immobilization (Yes = 0, No = 1) -1.319 0.381 0.267 0.127 to 0.564 .001 Note: The beta coefficients and odds ratios are indicative and should be calculated based on the actual logistic regression analysis. P-values less than 0.05 were considered to indicate statistical significance. Research Limitations and Future Directions Our study illuminates the characteristics of postoperative recurrence in thoracolumbar tuberculosis, yet it has limitations that may affect the generalizability of our findings. The limited sample size and loss to follow-up of five patients may compromise the comprehensiveness of our patient population representation with postoperative recurrence. Moreover, our focus on descriptive analysis, devoid of an exploration into the underlying molecular mechanisms and pathophysiology of recurrence, leaves a gap in our current understanding. To address these limitations, future research should aim to expand the sample size and utilize a multicenter, randomized, controlled trial design to enhance the generalizability and reliability of the findings. Employing basic science methodologies, including animal models and cellular assays, could reveal the molecular basis of thoracolumbar tuberculosis recurrence and facilitate more targeted clinical interventions. Furthermore, qualitative research methods, such as in-depth interviews and case studies, could enhance our understanding of the patient experience, illuminating a range of factors that may influence recurrence and providing a comprehensive guide for clinical management. Given the prominent role of drug-resistant tuberculosis in recurrence, future research should prioritize the surveillance and management of drug resistance. Tailoring anti-tuberculosis treatment regimens to individual patient profiles could establish a more robust scientific footing for diminishing recurrence rates and elevating patient outcomes in thoracolumbar tuberculosis. Declarations Acknowledgements No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. Author Contributions Qiang Zhou. and Lichuan Liang. designed the research, analyzed the data and wrote the manuscript. Chen Zhao. And Lei Luo. acquired data. Liehua Liu andQiang Zhou. performed surgical treatment. Pei Li. supervised the project and reviewed the manuscript. Conflict of Interest Statement The authors declare that they have no conflicts of interest. Data Statement (i) The data for this study were collected ：The study population comprised individuals diagnosed with thoracolumbar tuberculosis and treated consecutively at our institution from the year 2006 to 2019. The sources of the data include ：Medical Record Analysis: Utilizing our hospital's electronic medical record system, we extracted exhaustive medical histories for patients diagnosed with thoracolumbar tuberculosis. (ii) Radiographic Data Compilation: We assembled a comprehensive set of imaging data, encompassing X-rays, CT scans, MRI reports, and all other relevant radiographic documentation. (iii) Laboratory Data Collection: We meticulously gathered an extensive array of laboratory parameters, including complete blood counts, assessments of hepatic and renal function, erythrocyte sedimentation rates (ESR), C-reactive protein (CRP) levels, and additional relevant biochemical markers. (ⅳ) Clinical Presentations Documentation: Clinical findings were meticulously documented following an exhaustive review of medical records, which included the identification of local masses, sinus tracts, quantification of pain intensity, and evaluation of functional limitations. (ⅴ) Recurrence Analysis: A meticulous compilation of recurrent events was conducted, detailing the frequency and precise temporal patterns of recurrences, and systematically organizing related data, including the types of surgical procedures, postoperative care protocols, and the nutritional status of patients during the recurrence episodes. Data Availability Statement The data that support the findings of this study are available upon request from the corresponding author,Qiang Zhou. However, de-identified data may be shared with researchers who provide a methodologically sound proposal to achieve the goals of replicating the findings or conducting new valid research. Requests for access to the data should be directed to [email protected] , and will be evaluated by an independent data access committee. For researchers interested in accessing the data, the following conditions must be met: The research proposal must be submitted for review to the data access committee. The data will be made available in a secure environment, ensuring the protection of sensitive information. Any publications resulting from the use of the data must acknowledge the original source and provide appropriate citations. Please note that the data are the property of Department of spine surgery, the third affiliated hospital of Chongqing Medical University, Chong Qing, China, and any use of the data is subject to the terms and conditions set forth by the institution. References Global tuberculosis report 2023. (2023). https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2023 Garg, R. K. & Somvanshi, D. S. Spinal tuberculosis: A review. The Journal of Spinal Cord Medicine 34, 440–454 (2013). https://doi.org:10.1179/2045772311y.0000000023 Wang, Y. et al. Trends of spinal tuberculosis research (1994–2015). Medicine 95 (2016). https://doi.org:10.1097/md.0000000000004923 Ukunda, U. N. F. & Lukhele, M. M. The posterior-only surgical approach in the treatment of tuberculosis of the spine. The Bone & Joint Journal 100-B, 1208–1213 (2018). https://doi.org:10.1302/0301-620x.100b9.Bjj-2017-1326.R2 Dara, M., Dadu, A., Kremer, K., Zaleskis, R. & Kluge, H. H. P. Epidemiology of tuberculosis in WHO European Region and public health response. European Spine Journal 22, 549–555 (2012). https://doi.org:10.1007/s00586-012-2339-3 Johansen, I. S. et al. Characteristics and Clinical Outcome of Bone and Joint Tuberculosis From 1994 to 2011: A Retrospective Register-based Study in Denmark. Clinical Infectious Diseases 61, 554–562 (2015). https://doi.org:10.1093/cid/civ326 Bian, Z., Gui, Y., Feng, F., Shen, H. & Lao, L. Comparison of anterior, posterior, and anterior combined with posterior surgical treatment of thoracic and lumbar spinal tuberculosis: a systematic review. Journal of International Medical Research 48 (2019). https://doi.org:10.1177/0300060519830827 Zhao, C. et al. Surgical management of consecutive multisegment thoracic and lumbar tuberculosis: anterior-only approach vs. posterior-only approach. Journal of Orthopaedic Surgery and Research 15 (2020). https://doi.org:10.1186/s13018-020-01876-3 Qiu, J. et al. Comparison of anterior or posterior approach in surgical treatment of thoracic and lumbar tuberculosis: a retrospective case–control study. BMC Surgery 22 (2022). https://doi.org:10.1186/s12893-022-01611-1 Tang, K. et al. Clinical efficacy of three types of autogenous bone grafts in treatment of single-segment thoracic tuberculosis: A retrospective cohort study. International Journal of Medical Sciences 17, 2844–2849 (2020). https://doi.org:10.7150/ijms.47309 Sun, D. et al. Comparison of Anterior only and Combined Anterior and Posterior Approach in Treating Lumbosacral Tuberculosis. Scientific Reports 9 (2019). https://doi.org:10.1038/s41598-019-53800-3 Lei Yang, Z. L. Analysis and therapeutic schedule of the postoperative recurrence of bone tuberculosis. Journal of Orthopaedic Surgery and Research (2013). https://doi.org : DOI: 10.1186/1749-799X-8-47 Ren, H.-l., Jiang, J.-m., Wang, J.-x., Qu, D.-b. & Chen, J.-t. Is duration of preoperative anti-tuberculosis treatment a risk factor for postoperative relapse or non-healing of spinal tuberculosis? European Spine Journal 25, 3875–3883 (2016). https://doi.org:10.1007/s00586-016-4496-2 Wang, B. et al. Recurrent complex spinal tuberculosis accompanied by sinus tract formation: causes of recurrence and clinical treatments. Scientific Reports 8 (2018). https://doi.org:10.1038/s41598-018-25142-z Yao, Y. et al. Features of 921 Patients With Spinal Tuberculosis: A 16-Year Investigation of a General Hospital in Southwest China. Orthopedics 40 (2017). https://doi.org:10.3928/01477447-20171012-03 Weng, C.-Y. et al. Spinal Tuberculosis in Non-HIV-Infected Patients: 10 Year Experience of a Medical Center in Central Taiwan. Journal of Microbiology, Immunology and Infection 43, 464–469 (2010). https://doi.org:10.1016/s1684-1182(10)60072-2 Dahlan, R. H., Ompusunggu, S. E., Gondowardojo, Y. R. B., Priambodo, R. & Anugerah, S. W. Spinal tuberculosis: A case series and a literature review. Surgical Neurology International 13 (2022). https://doi.org:10.25259/sni_1201_2021 Rajasekaran, S., Soundararajan, D. C. R., Shetty, A. P. & Kanna, R. M. Spinal Tuberculosis: Current Concepts. Global Spine Journal 8, 96S-108S (2018). https://doi.org:10.1177/2192568218769053 Khanna, K. & Sabharwal, S. Spinal tuberculosis: a comprehensive review for the modern spine surgeon. The Spine Journal 19, 1858–1870 (2019). https://doi.org:10.1016/j.spinee.2019.05.002 Ferrer, M. F., Torres, L. G., Ramírez, O. A., Zarzuelo, M. R. & del Prado González, N. Tuberculosis of the spine. A systematic review of case series. International Orthopaedics 36, 221–231 (2011). https://doi.org:10.1007/s00264-011-1414-4 Shi, T. et al. Retrospective Study of 967 Patients With Spinal Tuberculosis. Orthopedics 39 (2016). https://doi.org:10.3928/01477447-20160509-03 Liebenberg, D., Gordhan, B. G. & Kana, B. D. Drug resistant tuberculosis: Implications for transmission, diagnosis, and disease management. Frontiers in Cellular and Infection Microbiology 12 (2022). https://doi.org:10.3389/fcimb.2022.943545 Iacobino, A., Fattorini, L. & Giannoni, F. Drug-Resistant Tuberculosis 2020: Where We Stand. Applied Sciences 10 (2020). https://doi.org:10.3390/app10062153 Farhat, M. et al. Drug-resistant tuberculosis: a persistent global health concern. Nature Reviews Microbiology (2024). https://doi.org:10.1038/s41579-024-01025-1 Lv, H. et al. Global prevalence and burden of multidrug-resistant tuberculosis from 1990 to 2019. BMC Infectious Diseases 24 (2024). https://doi.org:10.1186/s12879-024-09079-5 Cui, X., Li, L. t. & Ma, Y. z. Anterior and Posterior Instrumentation with Different Debridement and Grafting Procedures for Multi-Level Contiguous Thoracic Spinal Tuberculosis. Orthopaedic Surgery 8, 454–461 (2016). https://doi.org:10.1111/os.12288 Sharma, A., Chhabra, H. S., Mahajan, R., Chabra, T. & Batra, S. Magnetic Resonance Imaging and GeneXpert: A Rapid and Accurate Diagnostic Tool for the Management of Tuberculosis of the Spine. Asian Spine Journal 10 (2016). https://doi.org:10.4184/asj.2016.10.5.850 Fisahn, C. et al. Trends in Spinal Surgery for Pott’s Disease (2000–2016): An Overview and Bibliometric Study. Global Spine Journal 7, 821–828 (2017). https://doi.org:10.1177/2192568217735827 Frel, M. et al. Magnetic Resonance Imaging in Differentatial Diagnosis of Pyogenic Spondylodiscitis and Tuberculous Spondylodiscitis. Polish Journal of Radiology 82, 71–87 (2018). https://doi.org:10.12659/pjr.899606 Misra, U. K., Warrier, S., Kalita, J. & Kumar, S. MRI findings in Pott’s spine and correlating clinical progress with radiological findings. Neuroradiology 62, 825–832 (2020). https://doi.org:10.1007/s00234-020-02402-2 Shanmuganathan, R., Ramachandran, K., Shetty, A. P. & Kanna, R. M. Active tuberculosis of spine: Current updates. North American Spine Society Journal (NASSJ) 16 (2023). https://doi.org:10.1016/j.xnsj.2023.100267 Salari, N. et al. Global prevalence of drug-resistant tuberculosis: a systematic review and meta-analysis. Infectious Diseases of Poverty 12 (2023). https://doi.org:10.1186/s40249-023-01107-x Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-4600215\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Article\",\"associatedPublications\":[],\"authors\":[{\"id\":325707998,\"identity\":\"264ec741-61c2-4ed9-83ec-6f5f2e9364e7\",\"order_by\":0,\"name\":\"Lichuan Liang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"the third affiliated hospital of Chongqing Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Lichuan\",\"middleName\":\"\",\"lastName\":\"Liang\",\"suffix\":\"\"},{\"id\":325707999,\"identity\":\"43b5e892-dec8-46a0-9ed9-ca2124fe93dd\",\"order_by\":1,\"name\":\"Chen Zhao\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"the third affiliated hospital of Chongqing Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Chen\",\"middleName\":\"\",\"lastName\":\"Zhao\",\"suffix\":\"\"},{\"id\":325708000,\"identity\":\"936bcbf7-5dce-42ff-98d8-d26b31671bb3\",\"order_by\":2,\"name\":\"Lei Luo\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"the third affiliated hospital of Chongqing Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Lei\",\"middleName\":\"\",\"lastName\":\"Luo\",\"suffix\":\"\"},{\"id\":325708001,\"identity\":\"1d106a73-7e19-4485-ae12-ef22757137dc\",\"order_by\":3,\"name\":\"Liehua Liu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"the third affiliated hospital of Chongqing Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Liehua\",\"middleName\":\"\",\"lastName\":\"Liu\",\"suffix\":\"\"},{\"id\":325708002,\"identity\":\"bba0d58f-7c11-4383-85f7-9327c83eb636\",\"order_by\":4,\"name\":\"Pei Li\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"the third affiliated hospital of Chongqing Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Pei\",\"middleName\":\"\",\"lastName\":\"Li\",\"suffix\":\"\"},{\"id\":325708003,\"identity\":\"d1ea66ba-14a4-4310-af73-cc32d0d507ae\",\"order_by\":5,\"name\":\"Qiang Zhou\",\"email\":\"data:image/png;base64,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\",\"orcid\":\"\",\"institution\":\"the third affiliated hospital of Chongqing Medical University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Qiang\",\"middleName\":\"\",\"lastName\":\"Zhou\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-06-18 13:08:33\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-4600215/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-4600215/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":60910668,\"identity\":\"6537e8c5-0edd-4727-8ead-0afd0411e6ae\",\"added_by\":\"auto\",\"created_at\":\"2024-07-23 12:51:55\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":595289,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4600215/v1/d065b149-b855-4187-be3a-8f7639d651f8.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"\\u003cp\\u003eClinical Characteristics, Risk Factors, and Management Strategies of Postoperative Recurrence in Thoracolumbar Tuberculosis\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eThoracolumbar tuberculosis, an extrapulmonary form, poses a significant health challenge. According to the World Health Organization (WHO), tuberculosis was the second leading cause of death from a single infectious agent in 2022, following COVID-19, with an estimated 10\\u0026nbsp;million new infections annually [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. This condition is particularly prevalent among adults, peaking in the 30\\u0026ndash;50 age group and showing a rising trend among the elderly [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Clinically, patients present with pain, reduced mobility, fatigue, and weight loss, typically starting with pain that worsens upon movement (19). The standard treatment paradigm includes a combination of anti-tuberculosis medications, surgery, and rehabilitation, with a primary focus on medical management. Diagnostic imaging reveals bone destruction, intervertebral space narrowing, and sequestration of dead bone[\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e]. The standard treatment paradigm encompasses a combination of anti-tuberculosis drugs, surgical intervention, and rehabilitation, prioritizing medical management. Surgical intervention is also a component of this paradigm, with surgical consideration reserved for patients with treatment failure, neurological compromise, or significant bony destruction. The surgical approaches utilized in this study included anterior, posterior, and combined anterior-posterior procedures. A comparative analysis of these different surgical methods revealed no significant differences in terms of cure rates, bone graft fusion times, spinal deformity correction, or neurological function improvement among patients postoperatively. [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]\\u003c/p\\u003e \\u003cp\\u003eThe threat of postoperative recurrence poses a significant concern for patients following surgical intervention for thoracolumbar tuberculosis. These recurrences can arise from a multitude of factors, including varied postoperative anti-tuberculosis regimens, incomplete lesion eradication, nutritional deficits, compromised immunity, and inadequate immobilization. Recurrence rates in the tuberculosis patient population hover between 2.26% and 10.3%, significantly affecting quality of life and complicating treatment strategies [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. The recurrence rate in this study was statistically determined to be 5.2%. The clinical profile of recurrent cases may deviate from primary presentations, often leading to diagnostic delays and protracted treatment initiation due to subtle symptomatology. This study is poised to dissect the determinants of recurrence meticulously, with the goal of formulating targeted management protocols and intraoperative directives to mitigate this risk.\\u003c/p\\u003e \\u003cp\\u003eOur study aims to conduct a comprehensive examination of the multifaceted impact of postoperative recurrence on thoracolumbar tuberculosis, covering recurrence frequency, temporal patterns, treatment modalities, and the wider impact on patient quality of life. By meticulously examining a comprehensive series of recurrent cases, we aim to delineate the clinical nuances of thoracolumbar tuberculosis recurrence, thereby providing clinicians with a more precise tool for patient management.The study's scope encompasses the translation of research findings into tangible clinical strategies, aimed at preventing postoperative recurrence and improving treatment efficacy, with the ultimate goal of enhancing patient prognoses. The underlying hypothesis of our study posits that recurrence is intricately linked to a spectrum of factors, including patient age, gender, lesion site, surgical technique, treatment duration, and the issue of tuberculosis drug resistance. A retrospective and comprehensive analysis of a robust case series is essential for testing these hypotheses and exploring the full clinical significance of postoperative recurrence.\\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eHypothesis\\u003c/strong\\u003e \\u003cp\\u003eWe hypothesize that postoperative recurrence of thoracolumbar tuberculosis is significantly associated with multiple factors, including patient age, gender, lesion location, surgical method, treatment duration, and drug-resistant tuberculosis. To test this hypothesis, we will conduct a comprehensive retrospective analysis of a sizable patient cohort to clarify the multifaceted impact of postoperative recurrence.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cdiv id=\\\"Sec2\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eCurrent Research Status\\u003c/h2\\u003e \\u003cp\\u003eIn the context of recurrent spinal tuberculosis and its associated complications, including sinus tract formation, Yang L et al. [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e] conducted an insightful analysis to evaluate the comparative efficacy of various treatment strategies.Their findings highlighted the necessity of promptly adjusting treatment protocols upon encountering treatment ineffectiveness. Ren HL et al. [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]emphasized the critical role of initiating treatment with a robust anti-tuberculosis drug regimen, comprising four or five drugs, for patients facing postoperative recurrence. Their findings highlighted the necessity of promptly adjusting treatment protocols when faced with treatment ineffectiveness. Additionally, the study explored the pivotal influence of patients' pre- and post-surgical nutritional and emotional well-being on treatment efficacy, and the significant role of patient education in bolstering therapeutic adherence and confidence. Biao Wang et al. [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]advocated for the advantages of a unified posterior surgical approach involving debridement, osteotomy, correction, grafting, and fusion in managing recurrent thoracolumbar spinal tuberculosis with kyphosis. Collectively, these investigations have illuminated the current therapeutic landscape and have laid the groundwork for future advancements in clinical practice and research.\\u003c/p\\u003e \\u003cp\\u003eLimitations of Existing Research\\u003c/p\\u003e \\u003cp\\u003eDespite the informative nature of current research, it is deficient in delineating the subtle clinical characteristics of recurrent spinal tuberculosis cases. Our study aims to address this gap through an exhaustive case-by-case analysis, with the intention of revealing the intricate clinical features of recurrence. A notable absence is present within the literature concerning a detailed comparative analysis between primary and recurrent cases, resulting in a diagnostic and treatment lag for patients with recurrence. This deficiency hinders the synthesis of research findings. Furthermore, existing research efforts concerning the factors contributing to postoperative recurrence are disjointed and devoid of a cohesive, systematic discourse.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eBasic Information of Recurrence Patients\\u003c/p\\u003e \\u003cp\\u003eOur study included 69 patients with postoperative recurrence of thoracolumbar tuberculosis, comprising 40 males and 29 females. The age of participants at the time of initial surgery ranged from 5 to 67 years, with a mean of 36.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.2 years. The age at recurrence ranged from 7 to 69 years, averaging 37.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.5 years. Surgical approaches were anterior in 31 cases, posterior in 22, and a combination in 15 cases. Statistical analysis showed no significant differences in age, gender, or surgical approach among the groups with recurrence (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). A comprehensive summary of these findings is detailed in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003ePatient Characteristics\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCharacteristic\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCategory\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eNumber or Mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eRange\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eP-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGender\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMale/Female\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e40/29\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u0026gt;\\u0026thinsp;0.05\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge at Initial Diagnosis (years)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e36.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e5\\u0026ndash;67\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTotal Number of Patients\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e69\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge at Recurrence (years)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e37.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7\\u0026ndash;69\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u0026gt;\\u0026thinsp;0.05\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSurgical Approach\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAnterior/Posterior\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eAnterior: 31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u0026gt;\\u0026thinsp;0.05\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003ePosterior: 22\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCombined: 15\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"5\\\"\\u003eNote: No statistically significant differences were observed for gender, age at initial diagnosis, or surgical approach (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05).\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\n\\u003cp\\u003eClinical Presentations of Recurrence Patients\\u003c/p\\u003e \\n\\u003cp\\u003eAnalysis of recurrent site distribution revealed 13 cases of thoracic tuberculosis, 20 cases of thoracolumbar tuberculosis (specifically T11-L1), and the most prevalent site was lumbar tuberculosis, with 36 cases. Clinical manifestations included pain in 38 cases (55.1%), sinus tract formation in 33 (47.8%), and neurological deficits in 26 cases (37.7%). ASIA grading was Grade B in 2 cases, Grade C in 7, and Grade D in 17. Local masses were observed in 25 cases (36.2%). Additionally, 20 cases (29%) exhibited tuberculous toxic symptoms such as cough, sputum, low-grade fever, night sweats, fatigue, and weight loss. Notably, 14 cases (20.3%) presented with both sinus tracts and masses, and 9 cases (13.0%) had concurrent pain, tuberculous toxic symptoms, and neurological deficits. Concurrent systemic tuberculosis was identified in 28 patients (40.6%), including 2 cases with both pulmonary and urinary tuberculosis, and 1 case with tuberculous peritonitis. A comprehensive summary of these findings is detailed in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003eRadiographic Findings\\u003c/p\\u003e \\u003cp\\u003eRadiographic evaluations revealed paravertebral abscesses in 62 cases, representing 89.9% of the sample. Flowing abscesses were observed in 26 cases (37.7%), and kyphosis was present in 25 cases (36.2%). Complications associated with internal fixation hardware were noted in 23 cases (33.3%), including cases of screw loosening, screw breakage, titanium rod fractures, and titanium mesh collapses. A substantial proportion of cases, representing 60 (86.9%), presented with concurrent paravertebral and flowing abscesses. Furthermore, a smaller cohort of patients, encompassing 10 cases (14.5%), exhibited a triad of complications including kyphosis, unsuccessful bone graft fusion, and concurrent issues with internal fixation.A comprehensive summary of these findings is detailed in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eClinical and Radiographic Features of Recurrence\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"3\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFeature\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNumber of Cases\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003ePercentage\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRecurrence Site\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eThoracic Tuberculosis\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e13\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e18.8%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eThoracolumbar(T11-L1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e20\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e28.9%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLumbar Tuberculosis\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e36\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e52.2%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eClinical Manifestations\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePain\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e38\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e55.1%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSinus Tract Formation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e33\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e47.8%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNeurological Deficits\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e26\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e37.7%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLocal Mass\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e25\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e36.2%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTuberculous Toxic Symptoms\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e20\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e29.0%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCombined Manifestations\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSinus Tract and Mass\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e14\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e20.3%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePain, Toxic Symptoms, and Neurological Deficits\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e13.0%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eConcurrent Systemic Tuberculosis\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePulmonary Tuberculosis\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e28\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e40.6%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePulmonary and Urinary Tuberculosis\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.9%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTuberculous Peritonitis\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.4%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRadiographic Findings\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eParavertebral Abscess\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e62\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e89.9%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFlowing Abscess\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e26\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e37.7%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eKyphosis\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e25\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e36.2%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eInternal Fixation Complications\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e23\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e33.3%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eDrug Resistance\\u003c/p\\u003e \\u003cp\\u003eOf the 69 patients with recurrent disease, Mycobacterium tuberculosis culture and drug susceptibility data were available for 53. Drug resistance was detected in 22 cases, representing 41.5% of patients with evaluable data. The resistance profile comprised monodrug resistance in 1 case, polydrug resistance in 5, and multidrug resistance (MDR) in 16 cases. Notably, MDR accounted for 72.7% of detected resistance cases. Irregular adherence to anti-tuberculosis medication was observed in 11 cases, representing 50% of the total with drug resistance data.\\u003c/p\\u003e \\u003cp\\u003eLaboratory Tests\\u003c/p\\u003e \\u003cp\\u003eElevated C-reactive protein (CRP) levels were observed in 61 patients, accounting for 88.4% of the study cohort. CRP levels peaked at 71.6 mg/L, averaging 38.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;18.1 mg/L, which significantly exceeds the normal threshold of less than 8 mg/L. Erythrocyte sedimentation rate (ESR) was elevated in 57 patients (82.6%), with a maximum of 100 mm/h and an average of 51.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;21.4 mm/h, surpassing the normal limit of less than 20 mm/h. In addition to elevated CRP levels, anemia was diagnosed in 37 patients (53.6%), with an average hemoglobin level of 98.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;15.4 g/L. Hypoalbuminemia was also observed in 20 patients (28.9%), with an average albumin level of 34.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.1 g/L. Elevated ESR and CRP were observed in combination in 54 cases (78.3%), and hypoalbuminemia co-occurred with anemia in 17 cases (24.6%).A comprehensive summary of these findings is detailed in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eLaboratory Findings\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTest\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNumber of Cases\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD (Normal Range)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ePercentage\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eElevated C-Reactive Protein (CRP)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e61\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e38.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;18.1 mg/L (\\u0026lt;\\u0026thinsp;8 mg/L)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e88.4%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIncreased Erythrocyte Sedimentation Rate (ESR)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e57\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e51.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;21.4 mm/h (\\u0026lt;\\u0026thinsp;20 mm/h)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e82.6%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAnemia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e37\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e98.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;15.4 g/L (Males\\u0026thinsp;\\u0026lt;\\u0026thinsp;120 g/L, Females\\u0026thinsp;\\u0026lt;\\u0026thinsp;110 g/L)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e53.6%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHypoalbuminemia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e20\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e34.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.1 g/L (\\u0026lt;\\u0026thinsp;38 g/L)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e28.9%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eAnalysis of Recurrence Time Distribution and Frequency.\\u003c/p\\u003e \\u003cp\\u003eAmong the 69 patients studied, 43 (62.3%) experienced a single recurrence, while 26 (37.7%) had multiple recurrences. Of these, 20 patients had two recurrences, 5 had three, and one patient experienced four recurrences. Recurrence intervals were as follows: 10 cases within 6 months, 31 cases between 6 to 12 months, 8 cases between 12 to 18 months, 4 cases between 18 to 24 months, 3 cases between 24 to 36 months, 5 cases between 36 to 48 months, 3 cases between 48 to 60 months, and 5 cases beyond 60 months. The longest recurrence time observed was 84 months, an exceptional duration.A comprehensive summary of these findings is detailed in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eRecurrence Timing and Frequency\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"3\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCategory\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNumber of Cases\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003ePercentage\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRecurrence Frequency\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOnce\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e43\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e62.3%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTwice\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e20\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003e37.7%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eThrice\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFour times\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRecurrence Timing\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWithin 6 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e \\u003cp\\u003e76.9%\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e6\\u0026ndash;12 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e31\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e12\\u0026ndash;18 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e8\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e18\\u0026ndash;24 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e24\\u0026ndash;36 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e36\\u0026ndash;48 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e48\\u0026ndash;60 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBeyond 60 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLongest Recurrence Time\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e84 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eTuberculosis as a Systemic Disease and Recurrence Risk\\u003c/p\\u003e \\u003cp\\u003eThe primary clinical manifestations in patients with recurrent thoracolumbar tuberculosis include pain, sinus tract formation, and neurological deficits, whereas patients with primary tuberculosis predominantly present with pain, night sweats, and low-grade fever. Notably, only 55.1% of recurrent patients experience pain, a significantly lower rate than the 83\\u0026ndash;100% observed in primary patients [\\u003cspan additionalcitationids=\\\"CR16 CR17 CR18 CR19\\\" citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e] Additionally, the frequency of low-grade fever and night sweats is relatively lower in recurrent patients, which may be associated with the continuation of anti-tuberculosis medication during the recurrent phase for some patients. Particularly striking is the observation that 44.9% of recurrent patients in this study did not exhibit pain upon recurrence and also presented with fewer tuberculous toxic symptoms such as low-grade fever and night sweats. This finding suggests that the atypical clinical presentation in recurrent patients is a significant factor contributing to delayed diagnosis and treatment. Therefore, clinicians should remain vigilant about the possibility of recurrence, even in patients already undergoing anti-tuberculosis therapy. Furthermore, this study highlights the importance of long-term, regular follow-up for patients with thoracolumbar tuberculosis. Regular clinical assessments and imaging studies are crucial for the timely detection of signs of recurrence, allowing for the prompt initiation of treatment and improved patient prognosis. For patients without pain, physicians should pay closer attention to other clinical and radiological clues that may indicate recurrence.\\u003c/p\\u003e \\u003cp\\u003eTuberculosis, known for its systemic nature, often presents extrapulmonary, commonly involving the spine. In our region, pulmonary tuberculosis was identified in 14.4% of patients initially diagnosed with spinal tuberculosis [\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. Among patients with recurrence, a substantial 44.9% had concurrent tuberculosis in other systems, notably pulmonary (43.4%), urinary (2.9%), and tuberculous peritonitis (1.5%). Given the chronic and debilitating nature of tuberculosis, extended treatment can adversely impact liver and renal function and reduce appetite. Postoperative recurrence can exacerbate these conditions, potentially causing anemia, electrolyte imbalances, and protein depletion, thereby increasing the risk of malnutrition.Our comprehensive risk factor analysis highlights that malnourished patients are particularly susceptible to recurrence. Consequently, for tuberculosis management, emphasis is placed on a diet rich in nutrients and protein, with vigilant monitoring for anemia, hypoalbuminemia, and electrolyte levels.Symptomatic treatments, including immunomodulatory agents and blood transfusions, are often necessary in certain cases.Collectively, nutritional support is deemed as integral to treatment as anti-tuberculosis medications.\\u003c/p\\u003e \\u003cp\\u003eAnti-tuberculosis Medication and Drug Resistance Issues\\u003c/p\\u003e \\u003cp\\u003eAnti-tuberculosis medication forms the cornerstone of treatment for all patients with tuberculosis. The prevalence of primary and acquired drug-resistant tuberculosis is reported to be 3.4% and 25%, respectively [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]. In 2022, the average prevalence of multidrug-resistant tuberculosis among newly diagnosed cases was 3.9%, with the proportion of patients initially diagnosed with MDR/RR-TB remaining at approximately 3\\u0026ndash;4%. This figure rises to 18\\u0026ndash;21% among patients who have previously received treatment for tuberculosis [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]. Globally, the combined prevalence of multidrug-resistant tuberculosis stands at 11.6% [\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]. Among the 53 patients at our institution who underwent Mycobacterium tuberculosis culture and drug susceptibility testing, drug resistance was identified in 22 cases, amounting to a 41.5% resistance rate. This rate significantly exceeds the regional spinal tuberculosis resistance rate of 6.7% and is predominantly characterized by multidrug resistance, accounting for 72.7% of all resistant cases. Drug resistance in Mycobacterium tuberculosis arises from a complex interplay of biological, clinical, and microbiological factors, rather than a single mechanism [\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. This includes suboptimal or inadequate anti-tuberculosis treatment regimens, which increase the risk of developing genetically resistant strains; the complexity of granulomatous lesions and their poor vascularization, which impede drug distribution and lead to suboptimal drug concentrations, thus fostering the development of phenotypic and genetic drug resistance; the inherent high-level antibiotic resistance of Mycobacterium tuberculosis; the presence of non-replicating (NR) bacilli within granulomas, which exhibit phenotypic drug resistance; and chromosomal mutations that result in acquired drug resistance, generating genetically resistant strains. The findings from our logistic regression analysis underscore the significant role of drug-resistant tuberculosis in the recurrence of thoracolumbar tuberculosis. It is imperative that all patients undergo mycobacterial culture and drug susceptibility testing, with an emphasis on obtaining multiple samples, such as necrotic bone tissue, soft tissue, and pus, to enhance diagnostic accuracy. Upon confirmation of drug resistance, personalized anti-tuberculosis treatment regimens should be formulated for each patient based on their specific resistance profile. Moreover, given the mechanisms of tuberculosis drug resistance, particularly the impact of suboptimal or inadequate treatment durations, it is crucial to impress upon patients the importance of adhering to a standardized and comprehensive course of anti-tuberculosis medication.\\u003c/p\\u003e \\u003cp\\u003eInflammatory Markers and Recurrence Diagnosis\\u003c/p\\u003e \\u003cp\\u003eIn our cohort of patients undergoing primary surgery for thoracolumbar tuberculosis, 87.6% showed normalization of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) by the first postoperative month, rising to 96.7% within three months. In contrast, Cui et al. [\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]reported that both CRP and ESR returned to normal levels three months postoperatively.However, patients with recurrence exhibited significant increases in these markers, with elevated CRP in 88.4% and ESR in 82.6% of cases. Given their role as inflammatory indicators, CRP and ESR are essential for diagnosing recurrent thoracolumbar tuberculosis. Thus, postoperative surveillance for thoracolumbar tuberculosis should include CRP and ESR as routine assessments. Patients with persistently elevated marker levels three months post-surgery require more frequent laboratory and imaging evaluations.For patients whose levels of these markers do not return to normal within three months post-surgery, more frequent laboratory and imaging evaluations are warranted. Enhancing patient awareness of potential postoperative recurrence, alongside the standardization of anti-tuberculosis medication and nutritional support, can significantly reduce the likelihood of recurrence and expedite the diagnosis and management of affected patients.\\u003c/p\\u003e \\u003cp\\u003eRole of Imaging in Recurrence Diagnosis\\u003c/p\\u003e \\u003cp\\u003eIn spinal tuberculosis, the thoracic and lumbar vertebrae are commonly affected [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]. Interestingly, our study found a higher prevalence of lumbar tuberculosis (36 cases) than thoracic (13 cases) in recurrent cases, despite thoracic tuberculosis being more common overall. This discrepancy likely results from the increased mobility and load-bearing nature of the lumbar spine. Notably, no cervical tuberculosis recurrences were observed, and logistic regression suggested a potential link between inadequate postoperative fixation and increased recurrence risk related to spinal mobility and load-bearing. Given these findings, we recommend prioritizing spinal instrumentation in thoracolumbar tuberculosis surgeries, encompassing thorough intraoperative lesion debridement, spinal stability reconstruction, and the routine use of external orthotic devices for three months postoperatively, extended as needed for complex cases. This approach could reduce the likelihood of postoperative recurrence. The use of external orthotic devices is critical for limiting spinal motion, reducing mechanical stress on surgical sites, ensuring fusion and internal fixation stability, and aiding the healing process. MRI is the preferred imaging modality for early tuberculosis lesion detection [\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e], surpassing X-rays and CT in diagnostic efficacy [\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]. Considering the complex mechanisms of tuberculosis drug resistance, such as the barriers to drug distribution due to granulomatous lesion complexity and poor vascularization, thorough lesion debridement during surgery is essential for reducing drug resistance and recurrence risks. Our analysis indicated that a significant 76.8% of recurrences occurred within the first two postoperative years, which underscores the critical need for vigilant follow-up during this period and the indispensable role of MRI in diagnosing thoracolumbar tuberculosis, thereby enabling the early identification and prompt treatment of recurrent cases.\\u003c/p\\u003e \\u003cp\\u003ePostoperative Recurrence Monitoring and Management\\u003c/p\\u003e \\u003cp\\u003eImportance of Patient Education and Follow-up\\u003c/p\\u003e \\u003cp\\u003eA notable 26 patients (37.7%) within our cohort experienced multiple recurrences. It is essential for healthcare providers to proactively inform these patients about the possibility of further recurrences and to emphasize the importance of diligent self-monitoring. Education initiatives should enable patients to identify and report any symptomatic changes indicative of recurrence. Enhanced patient awareness of these symptoms can facilitate early detection of recurrence and prompt initiation of treatment strategies.\\u003c/p\\u003e \\u003cp\\u003eFor individuals who have undergone surgery for thoracolumbar tuberculosis, the initial two-year postoperative period is critical, being the period of highest recurrence risk. It is imperative that during this timeframe, healthcare providers rigorously monitor for symptoms indicative of recurrence, focusing particularly on pain, sinus tracts, local masses, and neurological deficits. Elevated erythrocyte sedimentation rate and C-reactive protein levels persisting beyond three months post-surgery should prompt a thorough investigation into the potential for recurrence. In cases of recurrent thoracolumbar tuberculosis, a concerted effort must be made to address the challenge of drug-resistant tuberculosis. Mycobacterial culture and drug susceptibility testing are essential for all patients, enabling the formulation of personalized anti-tuberculosis treatment plans aligned with each patient's resistance profile.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eOur study confirms the complex, multifactorial nature of postoperative recurrence in thoracolumbar tuberculosis and identifies several key risk factors. Through rigorous analysis, we propose a set of targeted management strategies that may significantly reduce the rate of recurrence. Our findings hold significant implications for clinical practice, particularly in enhancing post-surgical surveillance and treatment protocols for patients. The critical importance of early detection and intervention is paramount, as timely management is crucial for achieving better patient outcomes. We advocate for the adoption of our proposed strategies in clinical practice to improve patient care and reduce the disease burden.\\u003c/p\\u003e\"},{\"header\":\"Materials and Methods\",\"content\":\"\\u003cp\\u003eData Source and Collection\\u003c/p\\u003e \\u003cp\\u003eOur study included individuals diagnosed with thoracolumbar tuberculosis and consecutively treated at our facility from 2006 to 2019. We provide a detailed description of the methodologies used for data collection and subsequent analysis.\\u003c/p\\u003e \\u003cp\\u003eThe inclusion criteria were as follows: (i) individuals initially diagnosed with thoracolumbar tuberculosis who underwent lesion clearance with bone graft fusion and internal fixation surgery; (ii) those with postoperative recurrence admitted for inpatient treatment at our facility, with a mandatory minimum follow-up of 5 years.\\u003c/p\\u003e \\u003cp\\u003eExclusion criteria included cases where patients were lost to follow-up or chose to withdraw from the study at any point in the treatment continuum, leading to the exclusion of 5 patients.\\u003c/p\\u003e \\u003cp\\u003eIn accordance with the established criteria, this study enrolled a total of 69 patients with thoracolumbar tuberculosis. Specifically, 36 patients experienced recurrence following their initial surgery at our institution, while 33 patients had recurrences after their initial surgery performed at an external facility. The study cohort comprised 40 males and 29 females. To serve as a comparative group, we selected 657 patients from the same period who did not experience recurrence, and for whom clinical presentations, radiological data, and laboratory information were available for analysis.\\u003c/p\\u003e\\u003cp\\u003e(i) Medical Record Analysis: Using our hospital\\u0026apos;s information system, we retrieved comprehensive medical records for patients diagnosed with thoracolumbar tuberculosis.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e(ii) Radiographic Data Compilation: We compiled imaging data, including X-rays, CT scans, MRI reports, and other pertinent radiographic records.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e(iii) Laboratory Parameter Collection: We systematically collected a wide range of laboratory data, encompassing complete blood counts, hepatic and renal function tests, erythrocyte sedimentation rates (ESR), C-reactive protein (CRP) levels, and other pertinent biochemical indices.\\u003c/p\\u003e\\n\\u003cp\\u003e(ⅳ) Clinical Presentation Documentation: Clinical manifestations were meticulously documented through a thorough review of medical records. This included noting the presence of local masses, sinus tracts, grading pain intensity, and assessing functional limitations.\\u003c/p\\u003e\\n\\u003cp\\u003e(ⅴ) Recurrence Phenomenon Tabulation: A detailed tabulation of recurrence events was executed, recording the frequency of recurrences, specific timings, and collating associated data points such as the nature of surgical interventions, postoperative care regimens, and the nutritional status of patients at the time of recurrence.\\u003c/p\\u003e\\u003cp\\u003eApplication of Quantitative Analysis Methods\\u003c/p\\u003e \\u003cp\\u003eThis study leveraged a suite of quantitative analysis techniques to perform an in-depth statistical inquiry into the amassed data. The overarching goal was to delineate the clinical hallmarks of postoperative recurrence in patients with thoracolumbar tuberculosis. Our analytical framework encompassed both descriptive and regression analyses, utilizing SPSS 25.0 as the statistical engine.\\u003c/p\\u003e \\u003cp\\u003e\\u003cb\\u003eEthics\\u003c/b\\u003e. This study adheres to all relevant ethical guidelines and regulatory standards. The research protocols were reviewed and approved by the Ethics Committee of the Third Affiliated Hospital of Chongqing Medical University. Prior to their participation, informed consent was obtained from all participants involved in the study.\\u003c/p\\u003e \\u003cp\\u003e(ⅰ) Statistical Analysis\\u003c/p\\u003e \\u003cp\\u003eThe initial foray into our data set involved a descriptive statistical analysis, aimed at encapsulating the foundational characteristics of our patient cohort, including but not limited to age, gender, and disease trajectory. This approach allowed us to distill the demographic essence of the study population. For the subset of patients experiencing postoperative recurrence, key metrics such as recurrence rate, timing, and frequency were also analyzed descriptively. Graphical tools were employed to render the data distribution, providing a visual scaffold for grasping the overarching trends and patterns inherent in postoperative recurrence.See Table\\u0026nbsp;\\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e for details.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab5\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 5\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eChi-Square Analysis of Potential Recurrence Factors\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFactor\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eChi-Square Value\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eDegrees of Freedom\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eP-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGender (Male\\u0026thinsp;=\\u0026thinsp;0, Female\\u0026thinsp;=\\u0026thinsp;1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.011\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e.315\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e61.072\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e75\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e.877\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePresence of Pulmonary Tuberculosis\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e17.482\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIrregular Anti-Tuberculosis Medication Use\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e18.030\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDrug Resistance Status (Resistant\\u0026thinsp;=\\u0026thinsp;0, Susceptible\\u0026thinsp;=\\u0026thinsp;1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11.981\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePoor Nutritional Status (Yes\\u0026thinsp;=\\u0026thinsp;0, No\\u0026thinsp;=\\u0026thinsp;1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11.624\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSingle Vertebral Segment Involvement (Yes\\u0026thinsp;=\\u0026thinsp;0, No\\u0026thinsp;=\\u0026thinsp;1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.043\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e.835\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eStrictness of Postoperative Immobilization (Yes\\u0026thinsp;=\\u0026thinsp;0, No\\u0026thinsp;=\\u0026thinsp;1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e9.910\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e.002\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"4\\\"\\u003eNote: P-values less than 0.05 were considered to indicate statistical significance.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e\\n\\u003cp\\u003e(ⅱ) Regression Analysis\\u003c/p\\u003e \\n \\u003cp\\u003eIn a bid to unearth the determinants of postoperative recurrence, a battery of variables hypothesized to be linked to recurrence were subjected to regression analysis. Postoperative recurrence served as the dependent variable, while a spectrum of factors including age, gender, concomitant pulmonary tuberculosis, drug-resistant tuberculosis status, history of erratic anti-tuberculosis medication adherence, single-segment involvement, stringent postoperative immobilization, and nutritional integrity were considered as independent variables. A multivariate logistic regression model was engaged to probe the interrelation between these factors and the likelihood of postoperative recurrence. Notably, the study evaluated the candidacy of drug-resistant tuberculosis, nutritional status, and the rigor of postoperative immobilization as independent risk factors through logistic regression. To fortify the predictive validity of the model, a ROC (Receiver Operating Characteristic) curve analysis was integrated, offering a metric of accuracy and discriminatory power.See Table\\u0026nbsp;\\u003cspan refid=\\\"Tab6\\\" class=\\\"InternalRef\\\"\\u003e6\\u003c/span\\u003e for details.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab6\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 6\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eMultivariate Logistic Regression Analysis of Recurrence Factors\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"6\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFactor\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eBeta Coefficient\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eStandard Error\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eOdds Ratio\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e95% Confidence Interval\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eP-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGender (Male\\u0026thinsp;=\\u0026thinsp;0, Female\\u0026thinsp;=\\u0026thinsp;1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.212\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.300\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.236\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.687 to 2.225\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e.480\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePresence of Pulmonary Tuberculosis\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.475\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.336\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4.370\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.264 to 8.439\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIrregular Anti-Tuberculosis Medication Use\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.115\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.528\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8.288\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.947 to 23.312\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDrug Resistance Status (Resistant\\u0026thinsp;=\\u0026thinsp;0, Susceptible\\u0026thinsp;=\\u0026thinsp;1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.565\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.369\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4.783\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.322 to 9.850\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePoor Nutritional Status (Yes\\u0026thinsp;=\\u0026thinsp;0, No\\u0026thinsp;=\\u0026thinsp;1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.623\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.382\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e5.071\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.398 to 10.720\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSingle Vertebral Segment Involvement (Yes\\u0026thinsp;=\\u0026thinsp;0, No\\u0026thinsp;=\\u0026thinsp;1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.165\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.343\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.179\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.602 to 2.308\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e.631\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eStrictness of Postoperative Immobilization (Yes\\u0026thinsp;=\\u0026thinsp;0, No\\u0026thinsp;=\\u0026thinsp;1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e-1.319\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.381\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.267\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.127 to 0.564\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"6\\\"\\u003eNote: The beta coefficients and odds ratios are indicative and should be calculated based on the actual logistic regression analysis. P-values less than 0.05 were considered to indicate statistical significance.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e\"},{\"header\":\"Research Limitations and Future Directions\",\"content\":\"\\u003cp\\u003eOur study illuminates the characteristics of postoperative recurrence in thoracolumbar tuberculosis, yet it has limitations that may affect the generalizability of our findings. The limited sample size and loss to follow-up of five patients may compromise the comprehensiveness of our patient population representation with postoperative recurrence. Moreover, our focus on descriptive analysis, devoid of an exploration into the underlying molecular mechanisms and pathophysiology of recurrence, leaves a gap in our current understanding. To address these limitations, future research should aim to expand the sample size and utilize a multicenter, randomized, controlled trial design to enhance the generalizability and reliability of the findings. Employing basic science methodologies, including animal models and cellular assays, could reveal the molecular basis of thoracolumbar tuberculosis recurrence and facilitate more targeted clinical interventions. Furthermore, qualitative research methods, such as in-depth interviews and case studies, could enhance our understanding of the patient experience, illuminating a range of factors that may influence recurrence and providing a comprehensive guide for clinical management.\\u003c/p\\u003e \\u003cp\\u003eGiven the prominent role of drug-resistant tuberculosis in recurrence, future research should prioritize the surveillance and management of drug resistance. Tailoring anti-tuberculosis treatment regimens to individual patient profiles could establish a more robust scientific footing for diminishing recurrence rates and elevating patient outcomes in thoracolumbar tuberculosis.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNo benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor Contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eQiang Zhou. and Lichuan Liang. designed the research, analyzed the data and wrote the manuscript. Chen Zhao. And Lei Luo. acquired data.\\u003c/p\\u003e\\n\\u003cp\\u003eLiehua Liu andQiang Zhou. performed surgical treatment. Pei Li. supervised the project and reviewed the manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConflict of Interest Statement\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no conflicts of interest.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData Statement\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e(i) The data for this study were collected ：The study population comprised individuals diagnosed with thoracolumbar tuberculosis and treated consecutively at our institution from the year 2006 to 2019. The sources of the data include ：Medical Record Analysis: Utilizing our hospital\\u0026apos;s electronic medical record system, we extracted exhaustive medical histories for patients diagnosed with thoracolumbar tuberculosis.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e(ii) Radiographic Data Compilation: We assembled a comprehensive set of imaging data, encompassing X-rays, CT scans, MRI reports, and all other relevant radiographic documentation.\\u003c/p\\u003e\\n\\u003cp\\u003e(iii) Laboratory Data Collection: We meticulously gathered an extensive array of laboratory parameters, including complete blood counts, assessments of hepatic and renal function, erythrocyte sedimentation rates (ESR), C-reactive protein (CRP) levels, and additional relevant biochemical markers.\\u003c/p\\u003e\\n\\u003cp\\u003e(ⅳ) Clinical Presentations Documentation: Clinical findings were meticulously documented following an exhaustive review of medical records, which included the identification of local masses, sinus tracts, quantification of pain intensity, and evaluation of functional limitations.\\u003c/p\\u003e\\n\\u003cp\\u003e(ⅴ) Recurrence Analysis: A meticulous compilation of recurrent events was conducted, detailing the frequency and precise temporal patterns of recurrences, and systematically organizing related data, including the types of surgical procedures, postoperative care protocols, and the nutritional status of patients during the recurrence episodes.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData Availability Statement\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe data that support the findings of this study are available upon request from the corresponding author,Qiang Zhou. However, de-identified data may be shared with researchers who provide a methodologically sound proposal to achieve the goals of replicating the findings or conducting new valid research. Requests for access to the data should be directed to 651560@hospital.cqmu.edu.cn, and will be evaluated by an independent data access committee.\\u003c/p\\u003e\\n\\u003cp\\u003eFor researchers interested in accessing the data, the following conditions must be met:\\u003c/p\\u003e\\n\\u003cp\\u003eThe research proposal must be submitted for review to the data access committee.\\u003c/p\\u003e\\n\\u003cp\\u003eThe data will be made available in a secure environment, ensuring the protection of sensitive information.\\u003c/p\\u003e\\n\\u003cp\\u003eAny publications resulting from the use of the data must acknowledge the original source and provide appropriate citations.\\u003c/p\\u003e\\n\\u003cp\\u003ePlease note that the data are the property of Department of spine surgery, the third affiliated hospital of Chongqing Medical University, Chong Qing, China, and any use of the data is subject to the terms and conditions set forth by the institution.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eGlobal tuberculosis report 2023. (2023). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2023\\u003c/span\\u003e\\u003cspan address=\\\"https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2023\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGarg, R. K. \\u0026amp; Somvanshi, D. S. Spinal tuberculosis: A review. The Journal of Spinal Cord Medicine 34, 440\\u0026ndash;454 (2013). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1179/2045772311y.0000000023\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1179/2045772311y.0000000023\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWang, Y. \\u003cem\\u003eet al.\\u003c/em\\u003e Trends of spinal tuberculosis research (1994\\u0026ndash;2015). Medicine 95 (2016). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1097/md.0000000000004923\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1097/md.0000000000004923\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eUkunda, U. N. F. \\u0026amp; Lukhele, M. M. The posterior-only surgical approach in the treatment of tuberculosis of the spine. The Bone \\u0026amp; Joint Journal 100-B, 1208\\u0026ndash;1213 (2018). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1302/0301-620x.100b9.Bjj-2017-1326.R2\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1302/0301-620x.100b9.Bjj-2017-1326.R2\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDara, M., Dadu, A., Kremer, K., Zaleskis, R. \\u0026amp; Kluge, H. H. P. Epidemiology of tuberculosis in WHO European Region and public health response. European Spine Journal 22, 549\\u0026ndash;555 (2012). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1007/s00586-012-2339-3\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1007/s00586-012-2339-3\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eJohansen, I. S. \\u003cem\\u003eet al.\\u003c/em\\u003e Characteristics and Clinical Outcome of Bone and Joint Tuberculosis From 1994 to 2011: A Retrospective Register-based Study in Denmark. Clinical Infectious Diseases 61, 554\\u0026ndash;562 (2015). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1093/cid/civ326\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1093/cid/civ326\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBian, Z., Gui, Y., Feng, F., Shen, H. \\u0026amp; Lao, L. Comparison of anterior, posterior, and anterior combined with posterior surgical treatment of thoracic and lumbar spinal tuberculosis: a systematic review. Journal of International Medical Research 48 (2019). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1177/0300060519830827\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1177/0300060519830827\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eZhao, C. \\u003cem\\u003eet al.\\u003c/em\\u003e Surgical management of consecutive multisegment thoracic and lumbar tuberculosis: anterior-only approach vs. posterior-only approach. Journal of Orthopaedic Surgery and Research 15 (2020). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1186/s13018-020-01876-3\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1186/s13018-020-01876-3\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eQiu, J. \\u003cem\\u003eet al.\\u003c/em\\u003e Comparison of anterior or posterior approach in surgical treatment of thoracic and lumbar tuberculosis: a retrospective case\\u0026ndash;control study. BMC Surgery 22 (2022). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1186/s12893-022-01611-1\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1186/s12893-022-01611-1\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTang, K. \\u003cem\\u003eet al.\\u003c/em\\u003e Clinical efficacy of three types of autogenous bone grafts in treatment of single-segment thoracic tuberculosis: A retrospective cohort study. International Journal of Medical Sciences 17, 2844\\u0026ndash;2849 (2020). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.7150/ijms.47309\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.7150/ijms.47309\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSun, D. \\u003cem\\u003eet al.\\u003c/em\\u003e Comparison of Anterior only and Combined Anterior and Posterior Approach in Treating Lumbosacral Tuberculosis. Scientific Reports 9 (2019). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1038/s41598-019-53800-3\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1038/s41598-019-53800-3\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLei Yang, Z. L. Analysis and therapeutic schedule of the postoperative recurrence of bone tuberculosis. Journal of Orthopaedic Surgery and Research (2013). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e: DOI: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1186/1749-799X-8-47\\u003c/span\\u003e\\u003cspan address=\\\"10.1186/1749-799X-8-47\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRen, H.-l., Jiang, J.-m., Wang, J.-x., Qu, D.-b. \\u0026amp; Chen, J.-t. Is duration of preoperative anti-tuberculosis treatment a risk factor for postoperative relapse or non-healing of spinal tuberculosis? European Spine Journal 25, 3875\\u0026ndash;3883 (2016). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1007/s00586-016-4496-2\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1007/s00586-016-4496-2\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWang, B. \\u003cem\\u003eet al.\\u003c/em\\u003e Recurrent complex spinal tuberculosis accompanied by sinus tract formation: causes of recurrence and clinical treatments. Scientific Reports 8 (2018). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1038/s41598-018-25142-z\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1038/s41598-018-25142-z\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eYao, Y. \\u003cem\\u003eet al.\\u003c/em\\u003e Features of 921 Patients With Spinal Tuberculosis: A 16-Year Investigation of a General Hospital in Southwest China. Orthopedics 40 (2017). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.3928/01477447-20171012-03\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.3928/01477447-20171012-03\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWeng, C.-Y. \\u003cem\\u003eet al.\\u003c/em\\u003e Spinal Tuberculosis in Non-HIV-Infected Patients: 10 Year Experience of a Medical Center in Central Taiwan. Journal of Microbiology, Immunology and Infection 43, 464\\u0026ndash;469 (2010). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1016/s1684-1182(10)60072-2\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1016/s1684-1182(10)60072-2\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDahlan, R. H., Ompusunggu, S. E., Gondowardojo, Y. R. B., Priambodo, R. \\u0026amp; Anugerah, S. W. Spinal tuberculosis: A case series and a literature review. Surgical Neurology International 13 (2022). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.25259/sni_1201_2021\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.25259/sni_1201_2021\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRajasekaran, S., Soundararajan, D. C. R., Shetty, A. P. \\u0026amp; Kanna, R. M. Spinal Tuberculosis: Current Concepts. Global Spine Journal 8, 96S-108S (2018). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1177/2192568218769053\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1177/2192568218769053\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKhanna, K. \\u0026amp; Sabharwal, S. Spinal tuberculosis: a comprehensive review for the modern spine surgeon. The Spine Journal 19, 1858\\u0026ndash;1870 (2019). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1016/j.spinee.2019.05.002\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1016/j.spinee.2019.05.002\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFerrer, M. F., Torres, L. G., Ram\\u0026iacute;rez, O. A., Zarzuelo, M. R. \\u0026amp; del Prado Gonz\\u0026aacute;lez, N. Tuberculosis of the spine. A systematic review of case series. International Orthopaedics 36, 221\\u0026ndash;231 (2011). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1007/s00264-011-1414-4\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1007/s00264-011-1414-4\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eShi, T. \\u003cem\\u003eet al.\\u003c/em\\u003e Retrospective Study of 967 Patients With Spinal Tuberculosis. Orthopedics 39 (2016). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.3928/01477447-20160509-03\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.3928/01477447-20160509-03\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLiebenberg, D., Gordhan, B. G. \\u0026amp; Kana, B. D. Drug resistant tuberculosis: Implications for transmission, diagnosis, and disease management. Frontiers in Cellular and Infection Microbiology 12 (2022). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.3389/fcimb.2022.943545\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.3389/fcimb.2022.943545\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eIacobino, A., Fattorini, L. \\u0026amp; Giannoni, F. Drug-Resistant Tuberculosis 2020: Where We Stand. \\u003cem\\u003eApplied Sciences\\u003c/em\\u003e 10 (2020). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.3390/app10062153\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.3390/app10062153\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFarhat, M. \\u003cem\\u003eet al.\\u003c/em\\u003e Drug-resistant tuberculosis: a persistent global health concern. Nature Reviews Microbiology (2024). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1038/s41579-024-01025-1\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1038/s41579-024-01025-1\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLv, H. \\u003cem\\u003eet al.\\u003c/em\\u003e Global prevalence and burden of multidrug-resistant tuberculosis from 1990 to 2019. BMC Infectious Diseases 24 (2024). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1186/s12879-024-09079-5\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1186/s12879-024-09079-5\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCui, X., Li, L. t. \\u0026amp; Ma, Y. z. Anterior and Posterior Instrumentation with Different Debridement and Grafting Procedures for Multi-Level Contiguous Thoracic Spinal Tuberculosis. Orthopaedic Surgery 8, 454\\u0026ndash;461 (2016). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1111/os.12288\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1111/os.12288\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSharma, A., Chhabra, H. S., Mahajan, R., Chabra, T. \\u0026amp; Batra, S. Magnetic Resonance Imaging and GeneXpert: A Rapid and Accurate Diagnostic Tool for the Management of Tuberculosis of the Spine. Asian Spine Journal 10 (2016). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.4184/asj.2016.10.5.850\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.4184/asj.2016.10.5.850\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFisahn, C. \\u003cem\\u003eet al.\\u003c/em\\u003e Trends in Spinal Surgery for Pott\\u0026rsquo;s Disease (2000\\u0026ndash;2016): An Overview and Bibliometric Study. Global Spine Journal 7, 821\\u0026ndash;828 (2017). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1177/2192568217735827\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1177/2192568217735827\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFrel, M. \\u003cem\\u003eet al.\\u003c/em\\u003e Magnetic Resonance Imaging in Differentatial Diagnosis of Pyogenic Spondylodiscitis and Tuberculous Spondylodiscitis. Polish Journal of Radiology 82, 71\\u0026ndash;87 (2018). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.12659/pjr.899606\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.12659/pjr.899606\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMisra, U. K., Warrier, S., Kalita, J. \\u0026amp; Kumar, S. MRI findings in Pott\\u0026rsquo;s spine and correlating clinical progress with radiological findings. Neuroradiology 62, 825\\u0026ndash;832 (2020). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1007/s00234-020-02402-2\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1007/s00234-020-02402-2\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eShanmuganathan, R., Ramachandran, K., Shetty, A. P. \\u0026amp; Kanna, R. M. Active tuberculosis of spine: Current updates. North American Spine Society Journal (NASSJ) 16 (2023). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1016/j.xnsj.2023.100267\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1016/j.xnsj.2023.100267\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSalari, N. \\u003cem\\u003eet al.\\u003c/em\\u003e Global prevalence of drug-resistant tuberculosis: a systematic review and meta-analysis. Infectious Diseases of Poverty 12 (2023). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org:10.1186/s40249-023-01107-x\\u003c/span\\u003e\\u003cspan address=\\\"https://doi.org:10.1186/s40249-023-01107-x\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-4600215/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-4600215/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eObjective\\u003c/h2\\u003e \\u003cp\\u003eTo investigate the clinical characteristics and identify risk factors of postoperative recurrence in thoracolumbar tuberculosis, aiming to assess clinical significance and propose management strategies.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eRetrospective review of 69 patients' medical records with postoperative recurrence of thoracolumbar tuberculosis from 2006 to 2019, including demographics, clinical presentations, radiographic data, drug susceptibility, laboratory results, and recurrence patterns.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eThe study included 40 males and 29 females, with a mean age of 36.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.2 years at initial surgery and 37.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.5 years at recurrence. Manifestations included pain (55.1%), sinus tracts (47.8%), and neurological deficits (37.7%). Radiographic assessments showed paravertebral (89.9%) and flowing abscesses (37.7%). Drug resistance was present in 41.5% of cases. Inflammatory markers were elevated in most patients, with anemia and hypoalbuminemia frequently observed. Most recurrences occurred within 24 months post-surgery, with a maximum interval of 84 months, and 37.7% had multiple recurrences.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003ePostoperative recurrence in thoracolumbar tuberculosis is multifactorial, linked to drug-resistant tuberculosis, inconsistent medication adherence, poor nutrition, inadequate immobilization, and systemic tuberculosis infections. Optimal postoperative surveillance and clinical management necessitate a focus on inflammatory markers, advanced imaging, diligent patient education, and rigorous follow-up to diminish recurrence rates and enhance patient outcomes.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Clinical Characteristics, Risk Factors, and Management Strategies of Postoperative Recurrence in Thoracolumbar Tuberculosis\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-07-12 07:17:33\",\"doi\":\"10.21203/rs.3.rs-4600215/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"4843ab99-6368-44c1-9d19-2560b9ebd84a\",\"owner\":[],\"postedDate\":\"July 12th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[{\"id\":34494170,\"name\":\"Health sciences/Medical research/Epidemiology\"},{\"id\":34494171,\"name\":\"Health sciences/Medical research/Outcomes research\"},{\"id\":34494172,\"name\":\"Health sciences/Medical research/Study design\"},{\"id\":34494173,\"name\":\"Health sciences/Diseases/Infectious diseases\"},{\"id\":34494174,\"name\":\"Biological sciences/Neuroscience\"}],\"tags\":[],\"updatedAt\":\"2024-07-23T12:51:46+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-07-12 07:17:33\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-4600215\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-4600215\",\"identity\":\"rs-4600215\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}