Clinical efficacy of the surgical treatment of childhood onset lumbosacral tuberculosis

English Keywords:Lumbosacral tuberculosis  Lumbosacral kyphosis  Surgical treatment  Child

English Abstract:

  【Abstract】 Objectives: To investigate the clinical features of childhood onset lumbosacral tuberculosis and the preliminary efficacy of surgical treatment. Methods: 17 patients with childhood onset lumbosacral tuberculosis treated in our hospital between January 2009 and January 2019 were included into this study, including 7 males and 10 females, aged 17(9-26) years old on admission. Before operation, 4 cases were found combined with lumbar or sacral nerve root deficits, 14 cases were found combined with presacral abscess and dead bone formation and treated with quadruple antituberculosis drugs for more than 4 weeks, and the rest 3 cases were at quiescent stage of tuberculosis. Of all the cases, 11 underwent single posterior surgery and 6 underwent posterior-anterior surgery; 7 cases were treated with allograft bone grafting and 10 cases with autograft iliac bone; the proximal end was fixed with 2-3 pairs of pedicle screws, and for distal instrumentation, 9 cases were fixed with alar screws and S2 screws and 8 cases with iliac screws. Antituberculosis drug treatment was continued for at least 18 months after surgery. The destruction conditions of lumbosacral vertebrae were evaluated with full spine anteroposterior and lateral radiographs, 3D CT images, and MRIs, and the imaging parameters, such as preoperative and postoperative sacral-lumbar angle, Cobb angle of scoliosis, sagittal vertical axis(SVA), and central sacral vertical line(CSVL) deviation from C7 plumbline were measured, and clinical outcomes and complications were assessed. Results: Before operation, the loss of vertebral bodies was 2.95±3.62(1.9－4.6) with lumbosacral kyphosis angle of 16.22°±7.42°(4°－36°) and SVA of 11.43±8.12mm, and sagittal imbalance was presented in 4 patients with CSVL deviation of 23.12±2.12mm and scoliosis Cobb angle of 13.57°±5.51°. After operation, the lumbosacral angle was reduced to -13.21°±5.12°, corrected by 29.32°±6.32°(16°－48°). All patients were followed up for an average of 7.4 years(2.5－11 years) and bone healing was obtained in all patients without recurrence during follow-up. Postoperative complications included 3 cases of iatrogenic lumbosacral nerve root injury, of whom 1 was relieved after immediate postoperative release and 2 received conservative treatment; 3 cases of iliac screw breakage, 1 of whom with lumbosacral pain underwent revision surgery replacing iliac screw and receiving sacroiliac joint bone grafting, and the other 2 cases with no symptoms were given no special treatment. Conclusions: Childhood onset lumbosacral tuberculosis usually associated with prominent vertebral body loss and lumbosacral kyphosis. Sagittal imbalance was an uncommon presentation because of good adaptation of pelvic compensation. Single posterior or combined posterior-anterior procedures had good correction effects, but attention should be paid to internal fixation and nerve root complications.