One-stage anterolateral debridement, bone graft and internal fixation combined with local closed irrigation drainage for lumbar spinal tuberculosis with abscess

English Keywords:Lumbar spinal tuberculosis  Abscess  One-stage surgery  Closed irrigation drainage  Curative effect

English Abstract:

  【Abstract】 Objectives: To explore the outcome of one-stage anterolateral debridement, bone graft and internal fixation combined with local closed irrigation drainage for lumbar spinal tuberculosis with abscess. Methods: From January 2006 to December 2012, 18 patients(8 males and 10 females, aged 21-65 years, mean 44.6 years) suffering from lumbar spinal tuberculosis with abscess were reviewed retrospectively. The vertebral tuberculosis sites included L1-L2 in 1 patients, L2-L3 in 9 patients, L3-L4 in 7 patients, L4-L5 in 1 patient. Abscess was noted at L1-L3 in 1 case， L2-L4 in 6 cases， L2-L5 in 3 cases， L3-L5 in 5 cases， and L3-S1 in 3 cases. Based on Frankel′s classification, there were 3 cases of grade C, 14 of grade D, 1 of grade E. The average preoperative Barthel index(BI) was 65±10(range, 50-75); the average JOA was 18±4(range, 12-23). The preoperative ESR and CRP was (57±16.2)mm/h and (22.4±5.6)mg/L respectively; stenosis rate was(35.0±13.1)%; kyphosis angle was 25.3°±7.1°. Under systemic and routine antituberculosis chemotherapy, all patients received one-stage anterolateral debridement, bone graft and internal fixation. Postoperative persistent closed irrigation drainage and local chemotherapy with isoniazid were performed. Systemic antituberculosis therapy continued for 12-24 months(range, 18 months). The preoperative and postoperative Frankel neural function classification, lumbar JOA score, Barthel index as well as the preoperative, postoperative and follow-up Cobb angle, stenosis rate, ESR and CRP level were compared. Results: The average operation time was 3.0h(range, 2.5-5.0h), the average intraoperative blood loss was 450ml(range, 270-750ml), all patients had no serious complications. Postoperative persistent closed irrigation drainage and local chemotherapy with isoniazid lasted for 10 to 16 days(average, 14 days). The mean follow-up was 20 months(range, 12-30 months). Among 18 cases, 1 patients with Frankle C returned to D, 2 increased to E, 13 Frankle D recovered to E(88.9%, 16 cases with various degrees of recovery), 1 case remained no change, 1 Frankle E showed no neurological deficit. Postoperative Barthel index averaged 85±5(range, 75-90), 15 cases(83.3%) improved markedly; JOA score averaged 23±5(range, 17-29), 17 cases(94.4%) improved markedly. Postoperative ESR(18.2±6.3mm/h) and CRP(7.0±3.8mg/L) decreased significantly; stenosis rate recovered to (1.4±3.5)%, kyphosis angle recovered to 8.7°±2.6°. The postoperative ESR and CRP returned to normal within three months in all patients. X-ray showed bone fusion within 4-12 months(average, 6 months). During 1-year follow-up, the loss of correction was 1°-4°. At final follow-up, no recurrence was noted. Conclusions: Under systemic and routine antituberculosis chemotherapy, one-stage anterolateral debridement, bone graft and internal fixation combined with local closed irrigation drainage is effective and feasible for lumbar spinal tuberculosis with abscess.