Introduction Spondylitis tuberculosis can cause changes in spinopelvic parameters including pelvic incidence, pelvic tilt, and sacral slope due to biomechanical changes of the spine. Posterior instrumentation is one of the modality for the treatment of spondylitis tuberculosis. However, in Indonesia, clinical and radiological outcomes after posterior instrumentation in tuberculosis of lumbar vertebrae are still rare. This study aims to investigate the clinical and radiological outcomes of patients with spondylitis tuberculosis of the lumbar vertebrae after posterior instrumentation. Method This study was a cross-sectional study in patients with spondylitis tuberculosis of the lumbar vertebrae who underwent posterior instrumentation in Cipto Mangunsukumo and Fatmawati Hospital. Subjects were collected through consecutive sampling. 23 subjects were collected and analyzed. Clinical and radiological outcomes before and after posterior instrumentation were compared. The clinical outcome included the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). The radiological outcome included sacral slope, pelvic tilt, pelvic incidence, and lumbar lordosis. Results The median age of the subjects was 31 (9–57) years with a female-majority (60,9%). The median of the total vertebral infected was 2 (1–4). Median of VAS score before surgery, 6 months after surgery, and 12 months after surgery were 9 (4–10), 4 (1–7), dan 2 (1–6) (p < 0,001) consecutively. Median of ODI score before surgery, 6 months after surgery, and 12 months after surgery were 70 (40–86), 34 (10–74), dan 12 (2–74) (p < 0,001) consecutively. There was no significant difference in spinopelvic parameters before and after the surgery. The difference of ODI score before and after the surgery inversely correlated with the difference of lumbar lordotic and sacral slope. Conclusion Posterior instrumentation could improve clinical outcomes in patients with spondylitis tuberculosis of the lumbar. Change of lumbar lordotic and sacral slope after posterior instrumentation led to an improvement of quality of life marked by the reduction of the ODI score.

There are several options of surgical treatment of Hernia Nucleous Pulposus (HNP) such as discectomy and micro-endodiscectomy (MED). The fundamental differences between these procedures are the size of the incision, the discectomy procedure and the volume of disc taken. However, until now, there has not been any class 1 evidences explaining the efficacy of these procedures, and there is only a few studies about its safety and factors influencing its efficacy in treating HNP, especially in Indonesia. This study is aimed to assess clinical outcomes and safety of MED in HNP patients who underwent this procedure. Patient with HNP who underwent MED were followed prospectively in a period of January 2015 until December 2016. Clinical outcomes were evaluated by using Visual Analog Score (VAS) for assessing back pain and leg, and Oswestry Disability Index (ODI). The mean of pre-treatment score was compared with the mean of post-surgical treatment score by using paired t-test. Sampel were 78 HNP patients treated surgery. The average surgery duration (± SD) was 60 ± 17.1 minutes. The pretreatment score mean on VAS and ODI were 4.88 ± 1.10 and 35.21 ± 8.24. After surgical treatment, the VAS and ODI score obtained were significantly reduced to 1.53 ± 1.14 and 5.16 ± 5.52, respectively (p<0,001). A type of complication was observed, which was 5 (6.4%) cases of dural tear; no deficit in ankle dorsiflexion nor foot paresis were found. MED has been shown to be able to treat HNP with clinical outcomes similar to conventional open discectomy but with better levels of safety and effectiveness. However, this procedure still requires high quality randomized controlled trials studying about its efficacy and cost effectiveness in HNP treatment.

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