Clinical effect of simple posterior surgery combined with early continous intralesional chemotherapy through local catheterization for lumbosacral tuberculosis

HUANG Yunfei; YANG Xiaobin; LI Tian; ZHANG Xuefang; ZHAO Zhigang; CHANG Zhen; HAO Dingjun; HE Baorong; DU Jinpeng

doi:10.3969/j.issn.1674-666X.2024.03.001

Abstract：Objective To explore the clinical efficacy of posterior debridement,bone graft fusion and internal fixation combined with early continuous intralesional chemotherapy through local catheterization in the treatment of lumbosacral tuberculosis.Methods Clinical data of 32 patients with lumbsacral tuberculosis admitted to Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2014 to January 2018 were retrospectively analyzed.All patients were treated with simple posterior lesion removal,bone grafting fusion and internal fixation combined with early continuous chemotherapy with local catheterization(that is,intraoperative local catheterization,and postoperative continuous injection of isoniazid into the lesion via catheter for 1 month).Lumbosacral tuberculosis of all patients was mainly characterized by destruction of vertebral body and intervertebral space.A small amount of paravertebral or intraspinal abscess was present in 22 cases.The abscess was confined to the involved segment without distant injection or invasion to bilateral psoas major muscles.Operative time,intraoperative blood loss,bed time,perioperative complications,catheterization of anti-tuberculosis drugs and drug side effects were recorded.Visual analogue scale(VAS)scores and American Spinal Injury Association(ASIA)grading were evaluated before and after surgery.Graft fusion was observed by lumbar anteroposterior and lateral X-ray or 3D CT,and changes of erythrocyte sedimentation rate(ESR)and C-reaction protein(CRP)were also monitored.Results Operative time was(116.2±15.4)min,intraoperative blood loss was(320.2±103.4)mL,and the time in bed was(4.7±1.2)d.There were no major vascular or nerve injury or dural rupture cases,all wounds healed in one stage,and no deep infection occurred.Patients were followed up for 12 to 24 months(average,15 months).Bone fusion was achieved in all patients at 4 to 10 months after operation.ESR and CRP in all patients returned to normal at 3 months after operation.VAS score and kyphotic Cobb angle at the latest follow-up all improved when compared with preoperative ones(P<0.05).All 22 patients with preoperative nerve injuries recovered to different degrees at the last follow-up.There was no recurrence of tuberculosis at the last follow-up,and no serious adverse drug reactions occurred during the follow-up.Conclusion For single-segment lumbosacral tuberculosis mainly characterized by vertebral body and intervertebral space destruction,limited abscess in spinal canal or paraspinal region,and acompanying segmental instability and neurological injury,simple posterior surgery combined with early continous intra lesional chemotherapy through local catheterization could obtain satisfactory outcome.