One-Stage Anterolateral Surgical Treatment for Lumbosacral Segment Tuberculosis

Abstract

The purpose of this study was to evaluate clinical outcomes following one-stage anterior radical debridement, interbody fusion, and sacral rod fixation for the treatment of lumbosacral segment tuberculosis. From March 2004 to November 2008, 11 patients diagnosed with spinal tuberculosis received antituberculosis medications for two to three weeks before anterior radical debridement, autologous iliac bone grafting, and internal sacral rod fixation. Surgery was performed when the toxic symptoms of tuberculosis were controlled and erythrocyte sedimentation rates (ESR) decreased to 37.2 ± 9.6 mm/h (25-54 mm/h). Lumbosacral angle, visual analogue scale (VAS) pain, ESR, and neurological performance were assessed before and after surgery. All surgical procedures were performed successfully without intra or postoperative complication. There were no instances of spinal tuberculosis recurrence. Patients were followed-up for a mean of 19.6 months. The mean lumbosacral angle was significantly increased from the mean preoperative angle (12.9 ± 5.0°) both postoperatively (21.5 ± 6.1°) and at final follow-up (20.1 ± 5.2°) (both P <0.001). The mean VAS scores and ESR were significantly decreased from preoperative levels (7.3 ± 1.2 and 37.2 ± 9.6 mm/h, respectively) both postoperatively (1.5 ± 0.5 at month six and 10.4 ± 4.5 mm/h at month three, respectively) and at final follow-up (0.6 ± 0.5 and 10.5 ± 2.3 mm/h, respectively) (all P <0.001). Bone fusion occurred in all patients at a mean of nine months (range six to 12 months) after surgery. Three patients who had impaired neurological performance before surgery had normal neurological performance after surgery. Our findings suggest that anterior radical debridement, interbody fusion, and sacral rod fixation can be an effective treatment option for lumbosacral segment tuberculosis.