One-stage posterior debridement and single-segment interbody fusion for treating mono-segmental lumbar and lumbosacral spinal tuberculosis in adults following minimum 5-year follow-up

Zhenchao Xu,Xiyang Wang,Zheng Liu

doi:10.1186/s13018-020-02005-w

Abstract

BackgroundTo evaluate the mid-long-term outcomes of surgical management of mono-segmental lumbar and lumbosacral spinal tuberculosis (TB) in adults by one-stage posterior debridement, single-segment fixation, and titanium mesh cage interbody fusion.MethodsA total of 62 patients with mono-segmental lumbar or lumbosacral spinal tuberculosis were enrolled. One-stage posterior debridement, single-segment fixation, and titanium mesh cage interbody fusion was performed. Clinical and radiographic outcomes were compared and analyzed.ResultsAll patients were followed-up for an average of 75.0 ± 11.5 months and completely cured at the final follow-up. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) returned to normal within three months postoperatively. Postoperative Japanese Orthopedic Association (JOA) score, visual analog scale (VAS) and Oswestry Disability index (ODI) were significantly improved compared with preoperative values. Bony fusion occurred after an average of 9.8 ± 2.6 months. The lordosis angle and lumbosacral angle were increased from preoperative 20.4 ± 2.9° and 14.7 ± 3.4° to postoperative 32.8 ± 3.6° and 22.4 ± 5.5°, with angle loss of 1.0 ± 0.7° and 0.8 ± 0.7° at the final follow-up, respectively. No significant differences between preoperative and postoperative adjacent segment disc height (DH) were found.ConclusionsOne-stage posterior debridement, single-segment fixation, and titanium mesh cage interbody fusion represent effective and feasible treatment option for mono-segmental lumbar and lumbosacral spinal tuberculosis in adults. This approach may preserve lumbar normal motor units and decrease adjacent segment degeneration (ASD) with the advantages of minimal invasiveness and rapid postoperative rehabilitation.

Highlights

To evaluate the mid-long-term outcomes of surgical management of mono-segmental lumbar and lumbosacral spinal tuberculosis (TB) in adults by one-stage posterior debridement, single-segment fixation, and titanium mesh cage interbody fusion
The lumbar and lumbosacral spine are sites most commonly affected by spinal TB
We evaluated the effect of surgical treatment of mono-segmental lumbar and lumbosacral spinal TB in adults with one-stage posterior debridement, singlesegment fixation, and titanium mesh cage interbody fusion after at least 5 years of follow-up

Summary

Introduction

To evaluate the mid-long-term outcomes of surgical management of mono-segmental lumbar and lumbosacral spinal tuberculosis (TB) in adults by one-stage posterior debridement, single-segment fixation, and titanium mesh cage interbody fusion. According to the global TB report in 2019 by World Health Organization, TB is the second most common fatal infectious diseases. There are more than 10 million new TB cases worldwide in 2019, causing approximately 1.2 million deaths [1]. As the most common extrapulmonary TB, spinal TB accounts for approximately 50% cases of skeletal TB [2]. With the increasing rate of HIV infection and TB drug-resistant strains, the prevalence of spinal TB has recently continued to rise. The lumbar and lumbosacral spine are sites most commonly affected by spinal TB. This severe disease is accompanied by a high refractory, disability, and recurrence rate, which seriously influences the quality of patients’ life [3, 4]

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