Tesis

Perbandingan Luaran Tehnik Operasi Evakuasi Abses Sistem Tertutup (EAST) dan Debridemen Terbuka pada Kasus Abses Tuberkulosis Spinal = Comparison Of The Results Of Closed Abscess Evacuation Surgery Techniques (East) And Open Debridement In Cases Of Tuberculosis Abscess Of The Spine.

Latar belakang: Abses tuberkulosis spinal merupakan salah satu komplikasi serius dari infeksi tuberkulosis yang dapat menyebabkan kerusakan neurologis dan sulitnya eradikasi kuman. Tata laksana operatif dengan debridemen terbuka sering kali dipilih, terutama pada kasus abses yang luas. Namun, teknik minimal invasif telah mulai dikembangkan, termasuk Teknik Evakuasi Abses Sistem Tertutup (EAST), meski datanya masih terbatas. Keterbatasan tersebut mendasari penelitian ini yang bertujuan untuk menilai luaran klinis dan laboratoris pada pasien yang menjalani EAST dibandingkan debridemen terbuka. Metode: Penelitian ini menggunakan desain kohort retrospektif untuk membandingkan hasil antara operasi EAST dan debridemen terbuka pada pasien abses spinal tuberculosis. Data yang dikumpulkan mencakup karakteristik pasien, hasil laboratorium pascaoperasi (CRP), skala nyeri (VAS), lama rawat inap (LOS), komplikasi pascaoperasi, jaringan parut kulit, rekurensi infeksi, indeks disabilitas ODI, dan hasil Genexpert. Hasil: Sebanyak 48 subyek terkumpulkan pada penelitian ini dengan sebagian besar berjenis kelamin laki-laki (n=28, 58,3%). Usia pasien terbanyak pada 20-40 tahun (n=22, 45,8%), dan regio spondilitis terbanyak adalah regio lumbal (n=36, 75%). Tindakan EAST menunjukkan nilai VAS (VAS: 2 (0-5) vs 4 (3-5); p < 0,001) dan panjang jaringan parut kulit (jaringan parut: 0 vs 12 (8-20); p < 0,001) yang lebih rendah secara signifikan daripada debridemen terbuka. Kejadian rekurensi lebih banyak terjadi pada tindakan EAST, sedangkan kejadian komplikasi wound dehiscence lebih banyak terjadi pada debridemen terbuka. Kesimpulan: Tindakan EAST dapat digunakan sebagai alternatif terapi operatif abses tuberkulosis spinal luas dengan minimal atau tanpa deformiti. EAST menunjukkan luaran klinis VAS paska operasi yang lebih baik dan jaringan parut minimal daripada debridemen terbuka.
Kata kunci: abses tuberculosis spinal, evakuasi abses sistem tertutup, debridemen terbuka


Background: Spinal tuberculosis abscess is one of the serious complications of tuberculosis infection that can lead to neurological damage and difficulty in eradicating the pathogen. Open debridement surgery is often chosen, especially in cases of large abscesses. However, minimally invasive techniques, including closed system abscess evacuation (CSAE), have been developed, although data remains limited. This study was conducted to evaluate the clinical and laboratory outcomes of patients undergoing CSAE compared to open debridement. Methods: This retrospective cohort study compares the outcomes of CSAE and open debridement in patients with spinal tuberculosis abscess. Data collected included patient characteristics, postoperative laboratory results (CRP), postoperative pain scores (VAS), length of hospital stay (LOS), postoperative complications, skin scarring, recurrence of infection, disability index (ODI), and Genexpert results. Results: A total of 48 subjects were included in this study, with the majority being male (n=28, 58.3%). The most common age group was 20-40 years (n=22, 45.8%), and the most frequent region of spondylitis was lumbar (n=36, 75%). CSAE showed significantly lower VAS scores [VAS: 2 (0-5) vs 4 (3-5); p < 0.001] and smaller skin scars [scarring: 0 vs 12 (8-20); p < 0.001] compared to open debridement. Recurrence was more common with EAST, while wound dehiscence complications were more frequent with open debridement. Conclusion: CSAE procedure can be used as an alternative operative therapy for larga spinal tuberculous abscesses with minimal or without deformity. CSAE demonstrated better postoperative VAS clinical outcomes and minimal scarring than open debridement.
Keywords: spinal tuberculosis abscess, closed system abscess evacuation, open debridement.