Posterior pedicle screws with iliac bone grafts to repair multi-segmental lumbosacral tuberculosis:to reconstruct lumbosacral stability

Yu Ming; Qiu Nan-hai

doi:10.3969/j.issn.2095-4344.2015.09.011

Abstract：BACKGROUND:The treatment of lumbosacral tuberculosis with multi-segmental vertebral destruction is complex. Besides, debridement and relief of spinal cord compression, it is necessary to restore spine vertebral body height and stability of the spine. <br> OBJECTIVE:To investigate the surgical treatment effect of multi-segmental lumbosacral tuberculosis by posterior vertebral pedicle fixation and anterior debridement with autologous iliac bone graft. <br> METHODS:A total of 25 cases of L 2-S 2 vertebral tuberculosis with various degrees of damage, who were treated from March 2005 to December 2012, were selected in this study. After regular anti-tuberculosis treatment for 2-4 weeks, first-phase posterior pedicle screw fixation with anterior debridement and autologous iliac bone graft was performed. Postoperative X-ray and CT scan were conducted to assess bone fusion and deformity correction. Adverse events and material host reaction were recorded. <br> RESULTS AND CONCLUSION:After repair, average 16-month fol ow-up was performed. 23 cases of postoperative wound were total y healed, with 2 cases of incisions delaying healing, no sinus formation. After surgery, the lumbago and leg pain disappeared in al patients. During fol ow-up, graft displacement had no slippage, broken nails or broken rods. Within 6 months, bony fusion occurred. At 1 year after operation, there was no recurrence of tuberculosis with normal erythrocyte sedimentation. X-ray films showed lesion vertebra turned out to be bony union. Postoperative lumbosacral angle was 16°-36°, averagely 26°, and 15°-30° during final fol ow-up, averagely 20°. These results confirmed that one-stage debridement for multi-segmental lumbosacral tuberculosis and concomitant posterior pedicle fixation system for kyphosis correction therapy, which could reconstruct lumbosacral stability, and restore sagittal plane balance. Autologous iliac bone graft improved fusion rate and obtained satisfactory outcomes.