One-stage posterior lumbar debridement, interbody fusion, and posterior instrumentation in treating lumbar spinal tuberculosis

Abstract

Objective To analyze retrospectively clinical study efficacy and feasibility of one-stage posterior lumbar debridement,interbody fusion,and posterior instrumentation in treating lumbar spinal tuberculosis.Methods A total of 21 patients (14 males and 7 females) with lumbar tuberculosis collected from January 2009 to May 2012,underwent one-stage posterior lumbar debridement,interbody fusion,and posterior instrumentation.The age ranged 19 to 47 years (mean,34.8 years).All patients presented with presented with back pain,7 patients with constitutional symptoms including weakness,malaise,night sweats,fever and weight loss,2 with limbs numb and 1 with intermittence creep.Every patient underwent lumbar spine X -ray,CT scan and MRI examination of pathologic vertebra before surgery.All patients received at least a standard preoperative 2-4 week anti-tuberculosis treatment.Results All patients were confirmed by pathology or microbiology and were followed up for 12-48 months (mean,18 months).Average operation time was 3.1 h (range,2.5 to 4.3 h).Lumbar tuberculosis was completely cured and the grafted bones were fused 10 months after operation in all patients.There was no persistence or recurrence of infection and no nerve,blood vessel injury.After the treatment,the erythrocyte sedimentation rate (ESR) was decreased to normal level in 5.8 months.Conclusion With effective and standard anti-tuberculosis chemotherapy,the pedicle screw was placed due to pathologic vertebral body.One-stage posterior lumbar debridement,interbody fusion,and posterior instrumentation for lumbar tuberculosis could effectively relieve pain symptoms,and reconstruct the spinal stability. Key words: Lumbar vertebrae; Tuberculosis, Spinal; Spinal fusion