Selection of operation approach for lumbosacral tuberculosis treatment

English Keywords:Spinal tuberculosis  Lumbosacral vertebra  Surgery approach  Outcome

English Abstract:

  【Abstract】 Objectives: To analyze the clinical efficacy and indication of the two surgical approach choices in adult lumbosacral tuberculosis: simple posterior approach(P-approach) for debridement, fusion and instrumentation, one-stage combined posterior instrumentation and anterior debridement and fusion(PA-approach). Methods: Twenty-one patients with lumbosacral tuberculosis underwent operation in our hospital from January 2010 to November 2014, 11 males and 10 females, with a mean age of 38.9±14.3 years old(17-62 years old). The course of disease was 10-21 months, with an average of 16.1±2.7 months. Eight cases underwent P-approach operation including the patients with bone destruction but without abscess formation, spinal canal abscess formation or lower iliaca vessels bifurcation. Thirteen cases underwent PA-approach surgery including the patients with gravitation abscess formation, extensive bone destruction or high iliaca vessels bifurcation. All the patients were treated by antituberculous chemotherapy and nutrition support for 2-4 weeks preoperatively and 12-18 months postoperatively. The operation duration, bleeding volume, rest time on bed, visual analogue scale(VAS) score, nerve function recovery, clinical status and complications were recorded in all the patients. Bone graft fusion was assessed by X-ray or three-dimensional CT. The control of tuberculosis was assessed by erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP). Results: The average duration was 161.2±15.6min, intraoperative bleeding volume was 695.2±153.2ml, and rest time on bed was 8.5±2.5d in P-approach group, and those were 233.6±22.7min, 862.0±208.5ml and 16.9±2.0d respectively in PA-approach group. Compared with preoperative values, the VAS score, ESR and CRP of patients in two groups were statistically significantly improved at the final follow-up. Sinus tract formed in 2 cases who underwent P-approach surgery and cured after dressing change and anti-tuberculosis treatment with no revision surgery. Among patients undergoing PA-approach surgery, rupture of iliac vessels occured in 1 case and cured after vascular surgical repair. Retrograde ejaculation was observed in 1 male patient. On the final follow-up visit, all the patients in two groups achieved bone graft fusion with no failure of internal fixation. Conclusions: Simple posterior debridement, fusion and instrumentation work effectively in patients with bone destruction but without abscess formation, spinal canal abscess formation or lower iliaca vessels bifurcation. One-stage combined posterior instrumentation and anterior debridement and fusion is recommended for patients with gravitation abscess formation, extensive bone destruction or high iliaca vessels bifurcation.