Abstract:

Objective   To investigate a surgical treatment of lumbosacral tuberculosis by posterior debridement and internal fixation with iliac screws and pedicle screw, filling bone defects and intervertebral space with antibiotics&calcium phosphate.  Methods   A retrospective analysis of the clinical data was performed in 42 cases of lumbosacral tuberculosis patients (19 cases of male and 23 cases of female; age:19 to 75 year-old with an average of 38 years old) treated with two different surgical methods. Twenty-one patients with lumbosacral tuberculosis in the treatment group were treated by a single-stage posterior debridement and internal fixation with iliac screws and pedicle screws. Bone defects and intervertebral space filled with antibiotics-calcium phosphate were performed in these cases. 21 patients in the control group were implemented with anterior debridement and autogenous ilium grafts and vertebral pedicle screw fixation. All patients were followed up with an average of 12 months. Segmental lesions were L4/5~S1/2. 42 patients had varying degrees of kyphosis. The preoperative kyphosis angle was 5°~18° with an average of 9°.  Results After operation, spinal fusion was achieved in treatment group. Bone graft fusion time was 3 to 6 months with an average of 4 months, and that of control group ranged from 5 to 9 months with an average of 7 months. Postoperative imaging results showed that kyphosis was partly corrected. The postoperative kyphosis angle in the treatment group was 0~4° with a mean of 2°, but the postoperative kyphosis angle in the control group was 3°~11° with an average of 7° (P＜0.05). According to Chen score, among the 21 cases in the treatment group, the therapeutic efficacy was excellent in 17 patients, good in 2 patients. the excellent & good rate was 90.5%. However, The therapeutic efficacy was only excellent in 13 patients, good in 3 patients in the control group. the excellent & good rate was 76.2%. Lesion segments were stable and no recurrence was found in all final follow-up cases.   Conclusion    One-stage posterior debridement together with antibiotics-calcium phosphate grafting and internal fixation is an effective method for the treatment of lumbosacral tuberculosis.

Key words: Lumbosacral tuberculosis, Debridement, Calcium phosphate, Iliac screw, Fixation