One-Stage Anterolateral Debridement, Bone Grafting, and Internal Fixation for Treating Lumbosacral Tuberculosis

다국어 초록 (Multilingual Abstract)

Study Design: Retrospective case series.
Purpose: To investigate the clinical efficacy and feasibility of one-stage anterolateral debridement, bone grafting, and internal fixation for treating lumbosacral tuberculosis.
Overview of Literature: There has been no consensus regarding the optimal means of treating lumbosacral tuberculosis. The onestage anterolateral extraperitoneal approach for radical debridement, bone grafting, and internal fixation for treating lumbosacral tuberculosis is rare in literature.
Methods: Twenty-one patients with lumbosacral tuberculosis were retrospectively analyzed. All patients underwent the surgery of anterolateral debridement after regularly antituberculous drugs therapy. We evaluated the erythrocyte sedimentation rate, C-reactive protein, radiography, computed tomography, magnetic resonance imaging, visual analogue score, and Oswestry disability index before and after surgery.
Results: All patients completed a follow-up survey 9–48 months after surgery. All patients’ wounds healed well without chronic infection or sinus formation, and all patients with low-back pain reported relief after surgery. All cases had no tuberculosis recurrence.
Solid bony fusion was achieved within 6–12 months. At final follow-up, evaluated the erythrocyte sedimentation rate decreased from 38.1±12.5 to 11.3±7.1 mm/hr, C-reactive protein decreased from 6.2±4.2 to 1.6±1.3 mg/dL, the visual analog scale score decreased from 4.6±1.1 to 1.4±1.0, the Oswestry disability index score decreased from 50.2%±11.9% to 13.0%±6.6%, and the lumbosacral angle increased from 20.0°±4.8° to 29.0°±3.9° (p <0.05).
Conclusions: One-stage anterolateral debridement, bone grafting, and internal instrument fixation for treating lumbosacral tuberculosis is safe and effective.

참고문헌 (Reference)

1 Bezer M, "Tuberculous spondylitis of the lumbosacral region: long-term follow-up of patients treated by chemotherapy, transpedicular drainage, posterior instrumentation, and fusion" 18 : 425-429, 2005

2 Rajasekaran S, "Tuberculous lesions of the lumbosacral region: a 15-year follow-up of patients treated by ambulant chemotherapy" 23 : 1163-1167, 1998

3 Tuli SM, "Tuberculosis of the spine: a historical review" 460 : 29-38, 2007

4 Pun WK, "Tuberculosis of the lumbosacral junction: long-term follow-up of 26 cases" 72 : 675-678, 1990

5 Zhang T, "Treatment of lumbosacral spinal tuberculosis by one-stage anterior debridement and fusion combined with dual screw-rod anterior instrumentation underneath the iliac vessel" 17 : 49-, 2016

6 Mak KC, "Surgical treatment of acute TB spondylitis: indications and outcomes" 22 (22): 603-611, 2013

7 Aryan HE, "Standalone anterior lumbar discectomy and fusion with plate: initial experience" 68 : 7-13, 2007

8 Shah SP, "S1 tuberculosis treated with segmental lumbopelvic fixation: a case report" 37 : 866-869, 2012

9 Gautam MP, "Pott’s spine and paraplegia" 44 : 106-115, 2005

10 Sakho Y, "Pott’s disease in Senegal" 13 : 13-20, 2003

11 Wang Z, "Posterior mono-segmental fixation, combined with anterior debridement and strut graft, for treatment of the mono-segmental lumbar spine tuberculosis" 36 : 325-329, 2012

12 Song JF, "One-stage anterolateral surgical treatment for lumbosacral segment tuberculosis" 36 : 339-344, 2012

13 Talbot JC, "Musculoskeletal tuberculosis in Bradford: a 6-year review" 89 : 405-409, 2007

14 Ge Z, "Measurement of the concentration of three antituberculosis drugs in the focus of spinal tuberculosis" 17 : 1482-1487, 2008

15 Dailey AT, "Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 14: brace therapy as an adjunct to or substitute for lumbar fusion" 21 : 91-101, 2014

16 Calmels P, "Effectiveness of a lumbar belt in subacute low back pain: an open, multicentric, and randomized clinical study" 34 : 215-220, 2009

17 Liu P, "Distribution of three antituberculous drugs and their metabolites in different parts of pathological vertebrae with spinal tuberculosis" 36 : E1290-E1295, 2011

18 Lan X, "Debridement and allograft with internal fixation via combined anterior and posterior approach for treatment of lumbosacral tuberculosis" 25 : 1176-1179, 2011

19 Moon MS, "Conservative treatment of tuberculosis of the lumbar and lumbosacral spine" (398) : 40-49, 2002

20 Jin W, "Complete debridement for treatment of thoracolumbar spinal tuberculosis: a clinical curative effect observation" 14 : 964-970, 2014

21 He Q, "Comparison between the antero-posterior and anterior approaches for treating L5-S1 vertebral tuberculosis" 36 : 345-351, 2012

22 Jin W, "Clinical evaluation of the stability of single-segment short pedicle screw fixation for the reconstruction of lumbar and sacral tuberculosis lesions" 132 : 1429-1435, 2012

23 Connolly PJ, "Bracing of patients after fusion for degenerative problems of the lumbar spine: yes or no?" 23 : 1426-1428, 1998

24 Biedemann L, "Biomecanica of pedicle fixation as related to implant design" Springer 115-, 1994

25 Hodgson AR, "Anterior spine fusion for the treatment of tuberculosis of the spine: the operative findings and results of treatment in the first one hundred cases" 42 : 295-310, 1960

26 Wang Z, "Anterior debridement and bone grafting with posterior single-segment internal fixation for the treatment of mono-segmental spinal tuberculosis" 44 : 253-257, 2013

27 Suk SI, "Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis" 22 : 210-219, 1997