Application of anterior debridement and reconstruction with anatomical screw-plate fixation for lumbosacral tuberculosis: A 2-year-plus follow-up

Abstract

This study aimed to determine the efficacy and safety of anterior debridement and reconstruction with anatomical screw-plate fixation in patients with lumbosacral junction tuberculosis (TB).A total of 48 patients (30 males and 18 females) diagnosed with lumbosacral junction TB were included in this study. All patients underwent surgery in our institution from January 2008 to July 2014, using anterior debridement and reconstruction with anatomical screw-plate. Outcome data were evaluated before and after surgery and included lumbosacral angle, Frankel classification, bone fusion, and visual analog scale (VAS) scores.All patients were then followed up for an average of 49.4 months (range, 24-96 months). The mean lumbosacral angle improved from 8.36° ± 5.92° pre-operation to 22.38° ± 4.52° post-operation and 21.13° ± 3.73° during the final follow-up (both P < .05). Solid vertebral fusion was achieved in all patients after 7.6 months on average (range, 6-12 months). No severe complications appeared during operation and post-operation. Neurological performance and VAS scores were significantly improved compared with pre-operation (P < .05).Following standard anti-TB chemotherapy, anterior debridement and reconstruction with anatomical screw-plate fixation may be a feasible and effective therapeutical option for lumbosacral junction TB. This procedure can result in satisfactory bone fusion and deformity correction, and effectively restore lumbosacral junction stability.

Figure 1

Intraoperative images of a 30-year-old male. (A) A 5-cm median incision by the linea alba was made around the lesion level through the skin and along the symphysis pubis to the umbilicus. (B and C) Autologous iliac bone was packed to the prepared bone groove of the L5–S1 level. (D) Two anterior reconstructive anatomical screw-plates of suitable length were fixed anteriorly at the L5–S1 level.

Figure 2

The anatomical screw-plate system manufactured by the Zhejiang Guangci Medical Instrument Company presented the following advantages: the direction of the screw insertion is adjustable; the screw-plate system can be suited to the lumbosacral physiological curvature; the system allows long segment fixation; the screw-plate system had anti-back and self-lock features.

Figure 3

A 28-year-old woman underwent anterior debridement and reconstruction with anatomical screw-plate fixation for L5–S2 TB in our hospital. Preoperative, posteroanterior (A) and lateral (B) plain radiographs showed the L5–S2 vertebral damage with a narrowed intervertebral space and a decreased lumbosacral angle. The sagittal (C) and coronal (D) MRI views showed bony destruction from the L5 to S2 vertebrae, with prevertebral and paravertebral abscesses compressing the neural elements. Anteroposterior (E) and lateral (F) immediate postoperative radiographs showed the anterior column reconstruction with two 5.6-cm-long anatomical screw-plates across L5–S2.

Figure 4

A 26-year-old woman was diagnosed with L5-S1TB and underwent anterior debridement and reconstruction with anatomical screw-plate fixation. Before surgery, posteroanterior (A) and lateral (B) plain radiographs showed the L5–S1 vertebral damage with a narrowed intervertebral space and a decreased lumbosacral angle. The CT (C) and MRI (D) scans showed the destruction of L5 and S1 vertebrae, with a cold abscess compressing the neural elements. During the last follow-up visit, the x-ray images (E and F) showed a complete correction of the lumbosacral angle and a solid fusion.