Surgical strategies based on four clinical classifications of lumbosacral junction tuberculosis

Abstract

Objective To study the efficacy and safety of four surgical techniques of tuberculosis of lumbosacral junction retrospectively. Methods Between Jul 2001 and Jan 2013, 79 patients with lumbosacral spinal tuberculosis underwent surgery. Antituberculous chemotherapy and nutrition support prior to surgery were used for at least two weeks. 45 patients underwent single stage radical debridement, fusion and anterior instrumentation (A group). 18 patients underwent combined anterior and posterior spinal surgery (AP group), 10 patients underwent transpedicular drainage, posterior instrumentation, and fusion (P group), and 6 patients underwent anterior radical debridement (D group). All the patients were treated by antituberculous chemotherapy for 18 months and followed regularly. The operation duration, blood loss, clinical status, ESR, VAS, ODI, roentgenogram and 3D-CT were concerned to estimate the progress of tuberculosis. Radiographs were analyzed before surgery, immediately after surgery, and at the final follow-up examination to assess the result of anterior fusion and maintenance of correction. Results There was no injury of blood vessel, ureter or cauda equina during surgery. The mean follow-up period was 23 months (range 18-42 months). No obvious loss of deformity correction was observed. There was no recurrence, no tuberculous peritonitis, and no incidence of impotence or retrograde ejaculation in any of these patients. The average operating duration (min) were 144.31±23.18, 444.72± 141.63, 351.50±85.25, 90.00±29.66, respectively; The average blood loss (ml) were 266.67±104.45, 988.99±488.26, 890.00± 306.23, 200.00±104.88, respectively; The average Pre-op VAS were 4.71±1.79, 5.22±1.48, 3.30±1.64, 2.50±1.52, respectively; The average last follow-up VAS were 0.89±0.68, 0.90±0.74, 1.00±0.63, respectively; The average Pre-op ODI(%)were 29.64± 7.85, 32.17±7.59, 28.20±4.26, 20.67±4.63, respectively; The average last follow-up ODI(%)were 5.09±3.59, 4.78±3.78, 4.80± 3.39, 4.00±1.18, respectively; The average Pre-op lumbosacral angle (°)were 20.61±4.92, 23.78±5.84, 25.10±4.28, 21.67± 4.27, respectively; The average Post-op lumbosacral angle were 27.17±3.66, 30.56±5.31, 32.10±4.01, 24.83±2.32, respectively; The average last follow-up lumbosacral angle were 23.89±3.12, 27.00±5.46, 29.00±4.85, 23.33±2.50, respectively. Conclusion Single stage anterior interbody fusion with anterior instrumentation worked effectively to stabilize lumbosacral junction (less invasive, short surgical duration, no injury of posterior column). Anterior interbody fusion combined with posterior instrumentation was recommended for patients with extensive bone defect and low iliocava junction. Key words: Lumbar vertebrae; Sacrum; Tuberculosis, spinal; Treatment outcome; Follow-up studies