Single-position oblique lumbar interbody fusion combined with percutaneous pedicle screw internal fixation in the treatment of lumbar tuberculosis

English Keywords:Lumbar tuberculosis  Oblique lumbar interbody fusion  Single position  Percutaneous pedicle screw  Internal fixation

English Abstract:

  【Abstract】 Objectives: To explore the feasibility and evaluate the clinical effect of single-position oblique lumbar interbody fusion(OLIF) combined with percutaneous pedicle screw internal fixation in the treatment of lumbar tuberculosis. Methods: 35 patients with lumbar tuberculosis treated in our department from September 2018 to December 2019 with OLIF and percutaneous pedicle screw internal fixation were retrospectively reviewed, including 16 males and 19 females, aged 33 to 68 years(51.1±12.8 years). All patients received systematic anti-tuberculosis treatment before and after operation. C-reactive protein(CRP) and erythrocyte sedimentation rate(ESR) before and after operation, and operation time, intraoperative blood loss, postoperative complications, and bone graft fusion were recorded. The visual analogue scale(VAS) of pain, American Spinal Injury Association(ASIA) impairment scale, Oswestry disability index(ODI), Cobb angle of diseased segments, and lumbar lordosis were compared between before and after operation. Results: All patients underwent the operation uneventfully, the operation time was 125 to 280 minutes(168.8±51.4 minutes), and the intraoperative blood loss was 260-1500ml(347.5±121.7ml). All the 35 patients were followed up for 24-48 months(37.8±8.9 months). The ESR, CRP, VAS score and ODI decreased significantly at different follow-up time points(1, 3, and 6 month and final follow-up) than those before operation(P＜0.05), and their respective pairwise comparisons of each follow-up time point were with significant differences(P＜0.05). The Cobb angle and lumbar lordosis angle at different follow-up time points after operation were significantly smaller than those before operation(P＜0.05), while there was no significant difference in pairwise comparison between each time point after operation(P＞0.05). At final follow-up, ASIA grade of 13 patients with nerve injury was improved to varying degrees compared with those before operation, and bony fusion was achieved in all patients. 2 patients occurred continuous exudation at the mouth of the drainage tube with sinus formation, who were given dressing changes, adjustments of sensitive anti-tuberculosis drugs and nutritional supports, the incision healed at 3 months and 5 months after operation, respectively; 1 patient developed pulmonary infection with pleural effusion and 3 patients had varying degrees of drug-induced liver function injury, and they improved after conservative drug treatment. Conclusions: Single-position OLIF combined with percutaneous pedicle screw internal fixation is safe and feasible for the treatment of lumbar tuberculosis, which has the advantages of complete debridement and high bone fusion rate as well as small trauma, short operation time and rapid recovery after operation.