Debridement and Internal Fixation from a Single Posterior Approach for the Treatment of Lumbosacral Tuberculosis.

OBJECTIVE: To evaluate the application and therapeutic effects of debridement from a single posterior approach for bone grafting and internal fixation treatment of lumbosacral tuberculosis.

METHODS: From January 2010 to December 2016, 96 patients with lumbosacral tuberculosis were treated by single posterior debridement and internal fixation with bone graft. Among these patients, there were 9 cases involving the L3-L4 segment, 57 involving L4-L5, and 30 involving L5-S1. Interlaminar debridement was applied in 60 cases and transforaminal debridement was applied in 36 cases. Evaluation of therapeutic effects included the Prolo scale and visual analogue scale. The kyphotic angle and height loss of the vertebral body in the affected region of the lumbosacral segment were measured radiologically.

RESULTS: All patients were followed up for 12-24 months. In the interlaminar group, the mean preoperative, postoperative, and final kyphotic angles were -24.1 ± 5.5°, -34.6 ± 5.6°, and -32.1 ± 5.1°, respectively. In contrast, those in the transforaminal group were -25.1 ± 5.9°, -35.0 ± 6.6°, and -33.3 ± 5.9°, respectively. There was significant improvement of the postoperative angle compared with the preoperative angle. The result of the modified Prolo scale was 93.8%. According to the visual analogue scale, the preoperative and postoperative scales were 7.8 and 2.7, indicating a significant alleviation of pain.

CONCLUSIONS: Debridement from single posterior approach is an effective technique for the internal fixation of lumbosacral regional spinal tuberculosis. An appropriate selection of indications, careful evaluation of radiology, and thorough debridement were the key to a successful operation.