Skip to main content
SpringerLink
Log in

One-stage posterior debridement, transforaminal lumbar interbody fusion and instrumentation in treatment of lumbar spinal tuberculosis: a retrospective case series

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to compare the clinical outcomes of surgical management by one-stage posterior debridement, transforaminal lumbar interbody fusion (TLIF) and instrumentation and combined posterior and anterior approaches for lumbar spinal tuberculosis, and determine the clinical effectiveness of the posterior only surgical treatment for lumbar spinal TB at the same time.

Methods

Thirty-seven patients who suffered lumbar tuberculosis were treated by two different surgical procedures in our center from May 2004 to June 2012. All the cases were divided into two groups: 19 cases in Group A underwent one-stage posterior debridement, TLIF and instrumentation, and 18 cases in Group B underwent posterior instrumentation, anterior debridement and bone graft in a single-stage procedure. The operation time, blood loss, lumbar kyphotic angle, recovery of neurological function and fusion time were, respectively, compared between Group A and Group B.

Results

The average follow-up period for Group A was 46.6 ± 16.7 months, and for Group B, 47.5 ± 15.0 months. It was obvious that the average operative duration and blood loss of Group A was less than those of Group B. Lumbar tuberculosis was completely cured and the grafted bones were fused in 10 months in all patients. There was no persistence or recurrence of infection and no differences in the radiological results in both groups. The kyphosis was significantly corrected after surgical management. The average pretreatment ESR was 60.7 ± 22.5 mm/h, which became normal (9.0 ± 2.8 mm/h) within 3 months in all patients.

Conclusions

Surgical management by one-stage posterior debridement, TLIF and instrumentation for lumbar tuberculosis is feasible and effective. This approach obtained better clinical outcomes than combined posterior and anterior surgeries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Moon MS, Moon YW, Moon JL et al (2002) Conservative treatment of tuberculosis of the lumbar and lower lumbar spine. Clin Orthop 398:40–49

    Article  PubMed  Google Scholar 

  2. Moon MS (2006) Development in the management of tuberculosis of the spine. Curr Orthop 20:132–140

    Article  Google Scholar 

  3. Moon MS (2007) Tuberculosis of spine: contemporary thoughts on current issues and perspective views. Curr Orthop 27:364–379

    Article  Google Scholar 

  4. Zhang HQ, Wang YX, Guo CF et al (2011) One-stage posterior focus debridement, fusion, and instrumentation in the surgical treatment of cervicothoracic spinal tuberculosis with kyphosis in children: a preliminary report. Childs Nerv Syst 27:735–742

    Article  PubMed  CAS  Google Scholar 

  5. Talu U, Gogus A, Ozturk C et al (2006) The role of posterior instrumentation and fusion after anterior radical debridement and fusion in the surgical treatment of spinal tuberculosis: experience of 127 cases. J Spinal Disord Tech 19:554–559

    Article  PubMed  Google Scholar 

  6. Hodgson AR, Stock FE (1960) Anterior spine fusion for the treatment of tuberculosis of the spine: The operative findings and results of treatment in the first 100 cases. J Bone Jt Surg Am 42:295–310

    Google Scholar 

  7. Fukuta S, Miyamoto K, Masuda T et al (2003) Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis. Spine 28:E302–E308

    PubMed  Google Scholar 

  8. Hirakawa A, Miyamoto K, Takahiro M et al (2010) Surgical outcome of 2-stage (posterior and anterior) surgical treatment using spinal instrumentation for tuberculous spondylitis. J Spinal Disord Tech 23:133–138

    Article  PubMed  Google Scholar 

  9. Kim DJ, Yun YH, Moon SH et al (2004) Posterior instrumentation using compressive laminar hooks and anterior interbody arthrodesis for the treatment of tuberculosis of the lower lumbar spine. Spine 29:275–279

    Article  Google Scholar 

  10. Laheri VJ, Badhe NP, Dewnany GT (2001) Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine. Spinal Cord 39:429–436

    Article  PubMed  CAS  Google Scholar 

  11. Zhang HQ, Li JS, Guo CF et al (2012) Two-stage surgical management using posterior instrumentation, anterior debridement and allografting for tuberculosis of the lower lumbar spine in children of elementary school age: minimum 3-year follow-up of 14 patients. Arch Orthop Trauma Surg 132(9):1273–1279

    Article  PubMed  Google Scholar 

  12. Harms J, Jeszenszky D, Stolze D et al (1997) True spondylolisthesis reduction and more segmental fusion in spondylolisthesis. In: The textbook of spinal surgery, 2nd edn. Lippincott-Raven, Philadelphia, pp 1337–1347

  13. Zhang HQ, Lin MZ, Shen KY, Ge L, Li JS, Tang MX, Wu JH, Liu JY (2012) Surgical management for multilevel noncontiguous thoracic spinal tuberculosis by single-stage posterior transforaminal thoracic debridement, limited decompression, interbody fusion, and posterior instrumentation (modified TTIF). Arch Orthop Trauma Surg 132(6):751–757

    Article  PubMed  Google Scholar 

  14. Hirakawa A, Miyamoto K, Masuda T, Fukuta S, Hosoe H, Iinuma N, Iwai C, Nishimoto H, Shimizu K (2010) Surgical outcome of 2-stage (posterior and anterior) surgical treatment using spinal instrumentation for tuberculous spondylitis. J Spinal Disord Tech 23(2):133–138

    Article  PubMed  Google Scholar 

  15. Medical Research Council Working Party On Tuberculosis of the Spine (1982) A 10-year assessments of controlled trials comparing debridement and anterior spinal fusion in the management of tuberculosis of the spine in patients on standard chemotherapy in Hong-Kong. J Bone Jt Surg (Br) 64:393–398

    Google Scholar 

  16. Bhojraj S, Nene A (2002) Lumbar and lumbosacral tuberculous spondylodiscitis in adults. Redefining the indications for surgery. J Bone Joint Surg Br 84:530–534

    Article  PubMed  CAS  Google Scholar 

  17. Jain AK (2007) Tuberculosis of the spine. Clin Orthop Relat Res 460:39–49

    Article  PubMed  Google Scholar 

  18. Tuli SM (2007) Tuberculosis of the spine: a historical review. Clin Orthop Relat Res 460:29–38

    PubMed  CAS  Google Scholar 

  19. Zaveri GR, Mebta SS (2009) Surgical treatment of lumbar tuberculosis spondylodiscitis by transforaminal lumbar interbody fusion (TLIF) and posterior instrumentation. J Spinal Disord Tech 22:257–262

    Article  PubMed  Google Scholar 

  20. Fukuta S, Miyamoto K, Masuda T et al (2003) Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis. Spine 28:E302–E308

    PubMed  Google Scholar 

  21. Rajasekaran S, Soundarapandian S (1989) Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis. J Bone Joint Surg Am 71A:1314–1323

    Google Scholar 

  22. Garst RJ (1992) Tuberculosis of the spine: a review of 236 operated cases in an undeveloped region from 1954–1964. J Spinal Disord 3:286–299

    Article  Google Scholar 

  23. Lehmer S, Steffee A, Gaines R (1994) Treatment of L5–S1 spondyloptosis by staged L5 resection with reduction and fusion of L4 onto S1. Spine 19:1916–1925

    Article  PubMed  CAS  Google Scholar 

  24. Upadhyay SS, Saji MJ, Sell P et al (1996) The effect of age on the change in deformity after anterior debridement surgery for tuberculosis of the spine. Spine 21:2356–2362

    Google Scholar 

  25. Guven O, Kumano K, Talcin S et al (1994) A single stage posterior approach and rigid fixation for preventing kyphosis in the treatment of spinal tuberculosis. Spine 19:1039–1043

    Article  PubMed  CAS  Google Scholar 

  26. Mehta JS, Bhojraj SY (2001) Tuberculosis of the thoracic spine: a classification based on the selection of surgical strategies. J Bone Joint Surg Br 83:859–863

    Article  PubMed  CAS  Google Scholar 

  27. Govender S, Kumar KP (2003) Cortical allografts in spinal tuberculosis. Int Orthop 27(4):244–248

    Article  PubMed  CAS  Google Scholar 

  28. Govender S, Parbhoo AH (1999) Support of the anterior column with allografts in tuberculosis of the spine. J Bone Joint Surg Br 81(1):106–109

    Article  PubMed  CAS  Google Scholar 

  29. Govender S (2002) The outcome of allografts and anterior instrumentation in spinal tuberculosis. Clin Orthop Relat Res 398:60–66

    Article  PubMed  Google Scholar 

  30. Jain AK (2010) Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg Br 92(7):905–913

    Article  PubMed  CAS  Google Scholar 

  31. Ozdemir HM, Us AK, Ogun T (2003) The role of anterior spinal instrumentation and allograft fibula for the treatment of pott disease. Spine 28(5):474–479

    PubMed  Google Scholar 

Download references

Acknowledgments

This publication was funded in part by the Major Program of the Hunan Province Fu Rong Scholar Academy of Sciences.

Author information

Authors and Affiliations

  1. Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, ChangSha, 410008, China

    Hong-qi Zhang, Min-zhong Lin, Jin-song Li, Ming-xing Tang, Chao-feng Guo, Jian-huang Wu & Jin-yang Liu

Authors
  1. Hong-qi Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Min-zhong Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jin-song Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ming-xing Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chao-feng Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jian-huang Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jin-yang Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hong-qi Zhang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhang, Hq., Lin, Mz., Li, Js. et al. One-stage posterior debridement, transforaminal lumbar interbody fusion and instrumentation in treatment of lumbar spinal tuberculosis: a retrospective case series. Arch Orthop Trauma Surg 133, 333–341 (2013). https://doi.org/10.1007/s00402-012-1669-2

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-012-1669-2

Keywords

Search

Navigation