One-stage posterior debridement, interbody bone grafts and instrumentation for lumbosacral tuberculosis
LI Fei-hu
XIE En
HAO Ding-jun
WU Qi-ning
FAN Yong
ZHANG Zhen-xing
LIU Shi-chang
CHEN Guo-yong
Abstract：Objective To investigate the clinical outcomes of one-stage posterior debridement, interbody bone grafts and instrumentation for lumbosacral tuberculosis. Methods A total of 117 cases with lumbosacral tuberculosis from September 2012 to November 2015 were reviewed retrospectively. All patients underwent X-ray, CT and MRI examinations to determine the lesion segment ( L4 - S2 ). All patients had neurological dysfunction. Based on Frankel grade, 3 cases were of grade B, 60 cases grade C and 54 cases grade D. All patients received one-stage posterior debridement, interbody bone grafts and instrumentation, combining with local chemotherapy, preoperative and postoperative regular anti-tuberculosis treatment. Regular follow-up was conducted every 3 months. Erythrocyte sedimentation rate ( ESR ) and X-ray were applied to evaluate the tuberculosis, bone graft fusion, and changes of lumbosacral angle. Visual analogue scale ( VAS ) and Frankel ratings were used for re-evaluation at each follow-up. Results All patients were followed up for 10 - 21 months with the average of ( 12.6 ± 3.4 ) months. There were no severe complications intraoperatively and postoperatively. No recurrent cases of tuberculosis were found during the follow-up. The average lumbosacral angle recovered from ( 13.3 ± 5.4 ) ° preoperatively to ( 25.4 ± 5.2 ) ° 3 months postoperatively, ( 24.1 ± 4.9 ) ° in the latest follow-up. ESR decreased from ( 46.33 ± 19.98 ) mm / h preoperatively to ( 12.12 ± 3.56 ) mm / h 3 months postoperatively and ( 10.06 ± 2.50 ) mm / h 6 months postoperatively. VAS decreased from ( 6.23 ± 1.54 ) preoperatively to ( 1.92 ± 0.86 ) 3 months postoperatively, and ( 0.53 ± 0.51 ) 6 months postoperatively. There were statistical differences on lumbosacral angle, ESR and VAS preoperatively and postoperatively ( P < 0.05 ). Lumbar interbody fusion was achieved 8 - 12 months postoperatively ( the mean, 8.9 months ). No internal fixation loosening or fracture occurred. At the latest follow-up, 117 patients had different degrees of nerve function recovery. Frankel: 13 cases were of grade C, 36 cases grade D, 68 cases grade E. Conclusions For lumbosacral tuberculosis, the treatment of one-stage posterior debridement, interbody bone grafts and instrumentation, combining with positive anti-tuberculosis treatment before and after the surgery, is effective.
Keywords：Lumbar vertebraeSacrumTuberculosisspinalSpinal fusion
Publication Date：2017-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 954-958 )