One-stage posterior debridement and single-segment interbody fusion for treating mono-segmental lumbar and lumbosacral spinal tuberculosis in adults following minimum 5-year follow-up

Abstract

Background To evaluate the mid-long-term outcomes of surgical management of mono-segmental lumbar and lumbosacral spinal tuberculosis (TB) in adults by one-stage posterior debridement, single-segment fixation, and titanium mesh cage interbody fusion. Methods A total of 62 patients with mono-segmental lumbar or lumbosacral spinal tuberculosis were enrolled. One-stage posterior debridement, single-segment fixation, and titanium mesh cage interbody fusion was performed. Clinical and radiographic outcomes were compared and analyzed. Results All patients were followed-up for an average of 75.0 ± 11.5 months and completely cured at the final follow-up. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) returned to normal within three months postoperatively. Postoperative Japanese Orthopedic Association (JOA) score, visual analog scale (VAS) and Oswestry Disability index (ODI) were significantly improved compared with preoperative values. Bony fusion occurred after an average of 9.8 ± 2.6 months. The lordosis angle and lumbosacral angle were increased from preoperative 20.4 ± 2.9° and 14.7 ± 3.4° to postoperative 32.8 ± 3.6° and 22.4 ± 5.5°, with angle loss of 1.0 ± 0.7° and 0.8 ± 0.7° at the final follow-up, respectively. No significant differences between preoperative and postoperative adjacent segment disc height (DH) were found. Conclusions One-stage posterior debridement, single-segment fixation, and titanium mesh cage interbody fusion represent effective and feasible treatment option for mono-segmental lumbar and lumbosacral spinal tuberculosis in adults. This approach may preserve lumbar normal motor units and decrease adjacent segment degeneration (ASD) with the advantages of minimal invasiveness and rapid postoperative rehabilitation.

Medium‐Term Follow‐Up Outcomes of One‐Stage Posterior Lumbosacral or Lumbopelvic Fixation in the Management of Lumbosacral Junction Tuberculosis in Adults

“…The surgical method for the treatment of TB in the lumbosacral junction is still controversial 20 , 21 , 22 . An anterior approach has been conventionally preferred since most TB lesions involve the vertebral body and intervertebral discs.…”

Selection of the fusion and fixation range in the intervertebral surgery to correct thoracolumbar and lumbar tuberculosis: a retrospective clinical study

“…However, surgery is required for patients with severe spinal deformity, vertebral instability, cold abscess formation, spinal cord nerve injury, and paraplegia. In such cases, surgery can be used to significantly improve its cure rate and reduce recurrence and related complications [ 4 , 5 ]. A typical surgery protocol includes removal of the spinal tuberculosis lesions followed by autologous bone defect repair and lastly, internal fixation to restore the biomechanical stability of the spine [ 6 , 7 ].…”

The Comparative Influence of 2 and 4 Weeks Preoperative Antituberculosis Treatment on Spinal Tuberculosis Surgery: A Multicenter, Prospective, Randomized Clinical Trial

“…Furthermore, no well-designed, prospective clinical trial has been performed for addressing this question. According to some retrospective studies on spinal TB surgical treatment, preoperative ATT duration times were applied arbitrarily, i.e., from 1 day to 3 months, and sometimes even longer [8][9][10]. The influence of preoperative ATT duration on the prognosis of bone TB is highly conflicting.…”

“…The influence of preoperative ATT duration on the prognosis of bone TB is highly conflicting. Multiple studies found that preoperative ATT duration time did not cause differences in postoperative recurrence or non-healing of spinal TB [ 8 , 9 ], whereas Yang and Liu reported that inadequate preoperative ATT was an important risk factor of recurrence or non-healed spinal TB [ 10 ].…”