One-stage posterior surgical management of lumbosacral spinal tuberculosis with nonstructural autograft

Abstract

Objective: Lumbosacral spinal tuberculosis is rare in current population. Previous studies have reported effective outcomes about anterior, antero-posterior and posterior surgery for treating tuberculosis of lumbosacral region. However, the bone grafts used in these studies are mainly structural bone and mesh cage. The purpose of this study is to evaluate the efficacy and safety of nonstructural autograft in the surgical treatment of lumbosacral tuberculosis by one-stage posterior procedure.

Patients and methods: A total of 21 patients with lumbosacral tuberculosis were retrospectively reviewed between January 2012 and December 2014. All the patients underwent one-stage posterior debridement, interbody fusion with nonstructural autograft and posterior instrumentation. The preoperative and postoperative erythrocyte sedimentation rates (ESR), C-reactive protein (CRP) and visual analogue scale (VAS) were recorded. Preoperative and postoperative lumbosacral angle and intervertebral space height were measured on the plain films. American Spinal Injury Association (ASIA) Impairment Scale was used to evaluate the neurological outcomes of the patients.

Results: The average follow up period was 22.9±6.7months (range 12-36 months). The preoperative ESR and CRP were 33.4±10.5mm/h and 30.3±20.3mg/l, respectively, which decreased to 15.2±7.1mm/h and 10.6±5.8mg/l postoperatively with significant differences (P<0.05). The lumbosacral angles and intervertebral space height were increased from preoperative 20.4°±4.5° and 9.7±1.9mm to postoperative 25.6°±4.6° and 12.3±2.1mm, respectively (P<0.001 and P<0.001). At the final follow up, a loss of 2.1°of lumbosacral angles and 1.6mm of intervertebral space height was observed. The VAS scores were decreased from 4.73 to 2.71. Bony fusion was achieved in all patients at 6 months after surgery. Neurological outcomes were improved with 1-2 grades in most of the patients. One patient got wound infection and was cured by daily dressing. Complications related to instrumentation or neurological deficit weren't observed.

Conclusion: Combined with one-stage posterior debridement and instrumentation, interbody fusion with nonstructural autograft is an effective option for lumbosacral tuberculosis.

Keywords: Bone graft; Fusion; Lumbosacral tuberculosis; Posterior.