One-stage freehand minimally invasive pedicle screw fixation combined with mini-access surgery through OLIF approach for the treatment of lumbar tuberculosis

Abstract

Objective: To compare one-stage freehand minimally invasive pedicle screw fixation (freehand MIPS) combined with mini-access surgery through OLIF approach with posterior approach for treatment of lumbar tuberculosis (TB), and evaluate its feasibility, efficacy and safety in debridement, bone graft fusion and internal fixation.

Methods: 48 patients with single segment lumbar TB from June 2014 to June 2017 were included. Among them, 22 patients underwent one-stage freehand MIPS combined with mini-access surgery through OLIF approach (group 1), 26 patients were treated with posterior open surgery (group 2). Duration of operation, blood loss, and stay time in hospital were compared. Pre- and postoperative visual analog scale (VAS) pain scores, Oswestry disability index (ODI), erythrocyte sedimentation rate, complications and images were also recorded.

Results: Patients in group 1 showed significantly less blood loss (165 ± 73 ml vs 873 ± 318 ml, P < 0.001), shorter stay time in hospital (6/4-8 days vs 12/8-15 days, P < 0.001), while longer duration of operation (185 ± 14 min vs 171 ± 12 min, P < 0.001) than group 2 did. VAS scores significantly decreased after surgery in both groups, however, VAS scores of group 1 were significantly lower than that of group 2 immediately after surgery and during follow-ups (P < 0.001). ODI of group 1 was also significantly lower than that of group 2 at 12-month after surgery (P < 0.001).

Conclusion: One-stage freehand MIPS combined with mini-access surgery through OLIF approach is a feasible, efficient and safe method in treating single segment lumbar TB. It shows advantages of less surgical trauma and faster postoperative recovery.

Keywords: Bone graft fusion; Debridement; Lumbar tuberculosis; Minimally invasive spine surgery; OLIF; Pedicle screw fixation.

Fig. 1

A 20-year male patient with L4–L5 tuberculosis accompany with psoas abscesses. Preoperative MRI (A, B) and CT (C) showed destruction of L4–L5 and psoas abscesses. Freehand MIPS (D). Postoperative x-ray (E, F) and CT (G) showed good location of the autogenous iliac bone and internal fixation. CT at 12-month after surgery (H) showed bone fusion achieved without internal fixation failure. Surgical incisions of freehand MIPS (I) and OLIF (J)

Fig. 2

A 20-year male patient with L5–S1 tuberculosis accompany with psoas abscesses. Preoperative MRI (A, B) and CT (C) showed destruction of L5–S1 and psoas abscesses. Freehand MIPS and minimally invasive iliac screws (D). Postoperative x-ray (E, F) and CT (G) showed good position of the autogenous iliac bone and internal fixation. CT at 12-month after surgery (H) showed bone fusion achieved. Surgical incisions of freehand MIPS and iliac screws fixation (I) and OLIF (J)