Anterior debridement and fusion via paramedian retroperitoneal approach combined with posterior pedicle screw fixation for the treatment of lumbosacral junction tuberculosis

English Keywords:Spinal tuberculosis  Lumbosacral junction  Anterior debridement  Posterior instrumentation

English Abstract:

  【Abstract】 Objectives: To investigate the clinical effects of anterior debridement and fusion via paramedian retroperitoneal approach combined with posterior pedicle screw fixation for the treatment of lumbosacral junction tuberculosis. Methods: Twelve patients diagnosed with lumbosacral junction tuberculosis from October 2012 to March 2015 were analyzed retrospectively. Among whom, there were 9 males and 3 females, the average age was 43.9±18.4 years old. The levels of lesions were L4-S1. All cases underwent minimally invasive posterior fixation followed by anterior debridement and interbody fusion via the mini-open anterior paramedian retroperitoneal approach. All cases received anti-tuberculosis medications for 2 to 4 weeks, and surgery was performed when the toxic symptoms of tuberculosis were controlled and erythrocyte sedimentation rates(ESR) decreased. After operation, they were systematically and routinely treated with anti-tuberculous medications for 12-18 months. The operation time, the amount of bleeding during operation, major complications associated with approach, bone fusion were recorded. Visual analogue scale(VAS) pain, ESR, local lordotic angle(LLA) and neurological function were assessed before and after surgery. Results: All surgical procedures were performed successfully. The lesions removed during operation were proceeded by pathological examination and conformed to tuberculosis. The average operation time was 268.8±76.7min and the average amount of bleeding was 627.5±640.3ml. Intraoperative complications occurred in 3 patients which included iliolumbar vein tear in 1, peritoneal tear in 2. All 3 patients were not noted with severe sequelae after successful management. Patients were followed up for 12-48 months(mean 31.1 months), interbody fusion was obtained in all of them. There were no instances of spinal tuberculosis recurrence and signs of implant failure at the last follow-up. 8 cases with spinal cord injury recovered in different degrees after surgery. The mean VAS scores and ESR significantly decreased from preoperative levels(7.1±1.1 and 65.8±29.9mm/h, respectively) to 2.1±1.0 and 15.1±8.5mm/h at final follow-up, respectively(both P<0.05). The mean LLA significantly increased from the mean preoperative angle 3.0°±8.3° to postoperative 11.0°±6.0° and 10.4°±5.9° at final follow-up(both P<0.05). Conclusions: Based on systemic and routine anti-tuberculosis treatment, anterior debridement and fusion through paramedian retroperitoneal approach combined with posterior pedicle screw fixation is an effective treatment option for lumbosacral junction tuberculosis, which provides a less invasive, thorough debridement, high fusion rate and effective reconstruction of lumbosacral stability.