Utilization of second sacral alar-iliac technique for lumbosacral fixation in patients with tuberculosis of lumbar and sacrum spine

Abstract

Objective To evaluate the feasibility and clinical outcomes of second sacral alar-iliac (S2AI) technique utilized in patients with tuberculosis of Lumbosacral spine. Methods 24 cases (15 male, 9 female, aged 36-73 years old, average 47.1 years) of tuberculosis of Lumbosacral spine were collected for surgery using spinal and pelvic fixation system (S2AI or IS) between January 2014 and May 2016. Lumbosacral pain and restricted movement were noticed in all cases, of which 9 cases with radiating pain of lower limb and 7 cases with intermittent claudication, 2 cases with saddle anesthesia. Formal anti-tuberculosis medicine treatment was given for at least 2-3 weeks before operation. All patients with lumbosacropelvic fixation were compared by recording with ESR/CRP, preoperatively, postoperatively and the last following-up. The clinical effect oswestry disability index (ODI) score, visual analogue scale (VAS), ambulatory status, SF-36 scale and related complications of 2 groups were also compared. Results The average follow-up period was average 23.4 months in the two groups. The results show that operative time, blood loss, drainage time, hospitalization days and fusion time were not statistically significant; the recording of ESR, CRP, ODI, VAS scores and ambulatory status scores between S2AI and IS groups showed no significantly different, preoperatively, postoperatively and the last following-up. Comparisons within each group were improved at postoperatively and the last following-up related to preoperatively; The difference of the SF-36 scales in each group was statistically significant between preoperatively and the last following-up; There was no statistically difference in recurrence, sinus, pseudarthrosis between two groups, but The S2AI technique was associated with lower rates of symptomatic screw prominence compared to the IS technique. Conclusion Application of S2AI screw technique in the treatment of lumbosacral tuberculosis can achieve solid fixation and satisfactory clinical effect, and reduce the complications of traditional IS screws, which is an alternative method of posterior structure reconstruction of lumbosacral tuberculosis. Key words: Tuberculosis; Spinal diseases; Sacroiliac joint; Treatment outcome