Posterior intervertebral space debridement, annular bone grafting and instrumentation for treatment of lumbosacral tuberculosis

Abstract

Background: The choice of surgical methods for lumbosacral tuberculosis is controversial due to the complex anterior anatomy and peculiar biomechanics of the lumbosacral junction. The objective of this study was to explore the clinical effect of posterior intervertebral space debridement with annular bone graft fusion and fixation for the treatment of lumbosacral tuberculosis.

Methods: We retrospectively analysed data from 23 patients with lumbosacral tuberculosis who had undergone posterior intervertebral space debridement with annular bone fusion and fixation between January 2008 and September 2014. The mean age of the patients was 49.0 years (range, 27-71), and the mean duration of disease until treatment was 10.2 months (range, 6-20). The lumbosacral angle, visual analogue scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, American Spinal Injury Association (ASIA) grade and Social Functioning-36 (SF-36) score were determined to ascertain the clinical effects of the treatment.

Results: All patients underwent follow-up observation. The mean follow-up time was 34.2 months (range, 18-45), the mean operation time was 167.0 min (range, 130-210) and the mean blood loss was 767.4 ml (range, 500-1150). The lumbosacral angle was 21.0° ± 2.1° before operation, rising to 28.8° ± 1.7° after operation (p < 0.05) and being maintained thereafter. The mean VAS score before operation was 8.1 ± 0.6, decreasing to 1.2 ± 0.5 (p < 0.05) at the final follow-up. The mean ESR and CRP values were 49.1 ± 5.6 mm and 64.9 ± 11.9 mg/L, respectively, before operation, decreasing to normal at the final follow-up. The preoperative ASIA grade was C in 6 patients, D in 12 and E in 5. At the final follow-up, all patients had an ASIA grade of E except for one patient with a grade of D. For all patients, the SF-36 score at the final follow-up was higher than the preoperative and postoperative scores.

Conclusions: Posterior intervertebral space debridement with annular bone graft fusion and fixation is an effective treatment for lumbosacral spine tuberculosis.

Keywords: Bone graft; Fixation; Fusion; Intervertebral space debridement; Posterior.

Fig. 1

A 46-year-old female patient with lumbosacral tuberculosis with L4–5 lesions who underwent posterior intervertebral space debridement with annuar bone graft fusion and fixation. a-e Preoperative X-ray, computed tomography (CT) and magnetic resonance imaging showed bone destruction and abscess formation. f The intraoperative image showed posterior fixation, decompression and transintervertebral space debridement. g-j Postoperative radiographs. Postoperative CT in the axial and sagittal planes at 14 months showed a good position of internal fixation and excellent intervertebral bone fusion

Fig. 2

A 61-year-old female patient with lumbosacral tuberculosis with L5–S1 intervertebral lesion who also underwent posterior intervertebral space debridement with annular bone graft fusion and fixation. a-f Preoperative images. Preoperative computed tomography (CT) and magnetic resonance imaging showed bone destruction and extensive flow abscess (c–f). g-j Postoperative radiographs. Postoperative CT in the coronal and sagittal planes at 18 months showed a good position of internal fixation and excellent intervertebral bone fusion