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Single-stage approach of posterior debridement, allograft and internal fixation in management of lumbosacral tuberculosis

Jiawen Wu, Juanjuan Wang, Ming Kang, Hao Wang, Jingbiao Chen, Yuliang Huang, Qian Yue, Dejia Wang, Honghua Cai

Background: To evaluate clinical efficacy and safety of posterior debridement, allograft and internal instrumental fixation in the management of lumbosacral tuberculosis.

Methods: Fifteen patients diagnosed with lumbosacral tuberculosis were recruited in this study. All participants were scheduled to undergo posterior debridement, bone fusion, lumbar and sacral pedicle screw fixation or screw fixation in the bilateral iliac alar.

Results: The mean operation time was (170.5 ± 24.2) min. The average intraoperative haemorrhage volume was (980.3 ± 168.6) ml. No dural or the great artery injury was observed. No sinus tract formation was observed. All patients were followed up for 12 to 39 months. Bone fusion and internal fixation were successfully performed in 15 cases. All patients were completely recovered and no recurrence of tuberculosis was reported. Before surgery, 11 patients were diagnosed with decreased lower limb myodynamia of varying degree. During the last follow-up, the toe extension myodynamia was restored from grade III to grade IV in one case, and recovered to grade V in 10 patients. Postoperatively, 11 patients presented with lower leg or foot dermatalgia and hypopselaphesia. During subsequent follow-up, 2 patients were partially healed and 9 were fully recovered. Among 9 patients with knee or ankle hyporeflexia before surgery, 2 cases were partially treated and 7 were successfully healed. Prior to operation, 6 cases were positive for Lasegue's test and returned to normal after surgery.

Conclusions: Based upon conventional anti-tuberculosis medication, one stage posterior debridement, allograft and internal instrumental fixation is an efficacious and safe intervention for lumbosacral tuberculosis.