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One-stage posterior transforaminal lumbar debridement, 360° interbody fusion, and posterior instrumentation in treating lumbosacral spinal tuberculosis

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

Abstract

Purpose

Retrospective analysis of the clinical study efficacy and feasibility of one-stage posterior transforaminal lumbar debridement, 360° interbody fusion, and posterior instrumentation in treating lumbosacral spinal tuberculosis.

Method

A total of 21 patients with lumbosacral tuberculosis (TB) collected from January 2004 to January 2010, underwent one-stage posterior transforaminal lumbar debridement, 360° interbody fusion, and posterior instrumentation. In addition, the clinical efficacy was evaluated based on the data on the lumbo-sacral angle, neuro-logical status that was recorded by American Spinal Injury Association (ASIA) Impairment Scale, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), which were collected at specific time points.

Results

All cases were followed up for 16–36 months (average 24.9 ± 6.44 months). 18 patients suffered from evident neurological deficits preoperatively, of which 16 patients returned to normal at the final follow-up. Two patients with neurological dysfunction aggravated postoperative, experienced significant partial neurological recovery. With an effective and standard anti-TB chemotherapy treated, the values of ESR and CRP returned to normal levels 3-month later postoperative and maintained till the final follow-up. Preoperative lumbosacral angle was 20.89 ± 2.32° and returned 29.62 ± 1.41° postoperative. During long-term follow-up, there was only 1–3° lumbosacral angle loss. There was a significant difference between preoperative and postoperative lumbosacral angles.

Conclusion

With effective and standard anti-TB chemotherapy, one-stage posterior transforaminal lumbar debridement, 360° interbody fusion, and posterior instrumentation for lumbosacral tuberculosis can effectively relieve pain symptoms, improve neurological function, and reconstruct the spinal stability.

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References

  1. Bezer M, Kucukdurmaz F, Aydin N, Kocaoglu B, Guven O (2005) Tuberculous spondylitis of the lumbosacral region: long-term follow-up of patients treated by chemotherapy, transpedicular drainage, posterior instrumentation, and fusion. J Spinal Disord Tech 18(5):425–429

    Article  PubMed  Google Scholar 

  2. Pun WK, Chow SP, Luk KD, Cheng CL, Hsu LC, Leong JC (1990) Tuberculosis of the lumbosacral junction. Long-term follow-up of 26 cases. J Bone Jt Surg Br Vol 72(4):675–678

    CAS  Google Scholar 

  3. Bhojraj S, Nene A (2002) Lumbar and lumbosacral tuberculous spondylodiscitis in adults. Redefining the indications for surgery. J Bone Jt Surg Br Vol 84(4):530–534

    Article  CAS  Google Scholar 

  4. Jain AK, Dhammi IK (2007) Tuberculosis of the spine: a review. Clin Orthop Relat Res 460:39–49. doi:10.1097/BLO.0b013e318065b7c3

    Article  PubMed  Google Scholar 

  5. Jain AK (2010) Tuberculosis of the spine: a fresh look at an old disease. J Bone Jt Surg Br Vol 92(7):905–913. doi:10.1302/0301-620X.92B7.24668

    CAS  Google Scholar 

  6. Bailey HL, Gabriel M, Hodgson AR, Shin JS (1972) Tuberculosis of the spine in children. Operative findings and results in one hundred consecutive patients treated by removal of the lesion and anterior grafting. J Bone Jt Surg Am Vol 54(8):1633–1657

    CAS  Google Scholar 

  7. Hodgson AR, Stock FE (1994) Anterior spinal fusion. A preliminary communication on the radical treatment of Pott’s disease and Pott’s paraplegia. 1956. Clin Orthop Relat Res 300:16–23

    PubMed  Google Scholar 

  8. Five-year assessments of controlled trials of ambulatory treatment, debridement and anterior spinal fusion in the management of tuberculosis of the spine. Studies in Bulawayo (Rhodesia) and in Hong Kong. Sixth report of the Medical Research Council Working Party on tuberculosis of the spine (1978). J Bone Jt Surg Br Vol 60-B (2):163–177

  9. A five-year assessment of controlled trials of in-patient and out-patient treatment and of plaster-of-Paris jackets for tuberculosis of the spine in children on standard chemotherapy. Studies in Masan and Pusan, Korea. Fifth report of the Medical Research Council Working Party on tuberculosis of the spine (1976). J Bone Jt Surg Br Vol 58-B (4):399–411

  10. Lee CK, Vessa P, Lee JK (1995) Chronic disabling low back pain syndrome caused by internal disc derangements. The results of disc excision and posterior lumbar interbody fusion. Spine 20(3):356–361

    Article  PubMed  CAS  Google Scholar 

  11. Hodgson AR, Stock FE, Fang HS, Ong GB (1960) Anterior spinal fusion. The operative approach and pathological findings in 412 patients with Pott’s disease of the spine. Br J Surg 48:172–178

    Article  PubMed  CAS  Google Scholar 

  12. Bridwell KH, Lenke LG, McEnery KW, Baldus C, Blanke K (1995) Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine 20(12):1410–1418

    PubMed  CAS  Google Scholar 

  13. Govender S, Kumar KP (2003) Cortical allografts in spinal tuberculosis. Int Orthop 27(4):244–248. doi:10.1007/s00264-003-0446-9

    Article  PubMed  CAS  Google Scholar 

  14. Molinari RW, Bridwell KH, Klepps SJ, Baldus C (1999) Minimum 5-year follow-up of anterior column structural allografts in the thoracic and lumbar spine. Spine 24(10):967–972

    Article  PubMed  CAS  Google Scholar 

  15. Zhang HQ, Lin MZ, Ge L, Li JS, Wu JH, Liu JY (2012) Surgical management by one-stage posterior transforaminal lumbar debridement, interbody fusion, and posterior instrumentation for lumbo-sacral tuberculosis in the aged. Arch Orthop Trauma Surg. doi:10.1007/s00402-012-1604-6

    Google Scholar 

  16. Zhang HQ, Guo CF, Xiao XG, Long WR, Deng ZS, Chen J (2007) One-stage surgical management for multilevel tuberculous spondylitis of the upper thoracic region by anterior decompression, strut autografting, posterior instrumentation, and fusion. Journal of spinal disorders & techniques 20(4):263–267. doi:10.1097/01.bsd.0000211281.68400.1b

    Article  Google Scholar 

  17. Garg B, Kandwal P, Nagaraja UB, Goswami A, Jayaswal A (2012) Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis: a retrospective analysis. Indian J Orthop 46(2):165–170. doi:10.4103/0019-5413.93682

    Article  PubMed  Google Scholar 

  18. Tuli SM (2007) Tuberculosis of the spine: a historical review. Clin Orthop Relat Res 460:29–38. doi:10.1097/BLO.0b013e318065b75e

    PubMed  CAS  Google Scholar 

  19. Blondal K, Viiklepp P, Guethmundsson LJ, Altraja A (2012) Predictors of recurrence of multidrug-resistant and extensively drug-resistant tuberculosis. Int J Tuberc Lung Dis: Off J Int Union Against Tuberc Lung Dis 16(9):1228–1233. doi:10.5588/ijtld.12.0037

    Article  CAS  Google Scholar 

  20. McGreevy J, Jean Juste MA, Severe P, Collins S, Koenig S, Pape JW, Fitzgerald DW (2012) Outcomes of HIV-infected patients treated for recurrent tuberculosis with the standard retreatment regimen. Int J Tuberc Lung Dis: Off J Int Union Against Tuberc Lung Dis 16(6):841–845. doi:10.5588/ijtld.11.0210

    CAS  Google Scholar 

  21. Zaveri GR, Mehta SS (2009) Surgical treatment of lumbar tuberculous spondylodiscitis by transforaminal lumbar interbody fusion (TLIF) and posterior instrumentation. Journal of spinal disorders & techniques 22(4):257–262. doi:10.1097/BSD.0b013e31818859d0

    Article  Google Scholar 

  22. Moon WH (2006) The development of NRMIS (Nursing Resources Management Information System)—focused on patient classification. Stud Health Tech Informa 122:868–869

    Google Scholar 

  23. Weinstein JN, Rydevik BL, Rauschning W (1992) Anatomic and technical considerations of pedicle screw fixation. Clin Orthop Relat Res 284:34–46

    PubMed  Google Scholar 

  24. Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH (2012) The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat. doi:10.1111/j.1469-7580.2012.01564.x

    Google Scholar 

  25. Biedemann L (1994) Biomechanics of pedicle fixation as related to implant design, 1st American-European meeting on pedicle fixation of the spine and other advanced techniques. Springer, Munich, p 115

    Google Scholar 

  26. Jin W, Wang Z (2012) Clinical evaluation of the stability of single-segment short pedicle screw fixation for the reconstruction of lumbar and sacral tuberculosis lesions. Arch Orthop Trauma Surg 132(10):1429–1435. doi:10.1007/s00402-012-1575-7

    Article  PubMed  Google Scholar 

  27. Flierl MA, Beauchamp KM, Bolles GE, Moore EE, Stahel PF (2009) Fatal outcome after insufficient spine fixation for pyogenic thoracic spondylodiscitis: an imperative for 360 degrees fusion of the infected spine. Patient Saf Surg 3(1):4. doi:10.1186/1754-9493-3-4

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This publication was funded in part by the National Natural Science Foundation of China (81171736).

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The authors declare that they have no conflict of interest.

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Correspondence to Xiyang Wang.

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Pang, X., Wu, P., Shen, X. et al. One-stage posterior transforaminal lumbar debridement, 360° interbody fusion, and posterior instrumentation in treating lumbosacral spinal tuberculosis. Arch Orthop Trauma Surg 133, 1033–1039 (2013). https://doi.org/10.1007/s00402-013-1751-4

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