One-stage Posterior Radical Eradication,Bone Graft Fusion And Instrumentation In Treating Of The Lumbosacral Tuberculosis

Objective: To investigate the feasibility, clinical indications and significance of one-stage posterior radical eradication, bone graft fusion and instrumentation in treatment of the lumbosacral tuberculosis. Methods: Sixteen cases with tuberculosis of the lumbosacral spine were treated by one-stage posterior radical eradication, bone graft fusion and instrumentation fixation. All patients included 5 males and 11 females, and the average age was 38 years (range 20 -56 years). The affection segment of L_4/5 was seven and L₅/S₁ was nine. ESR(erythrocyte sedimentation rate), Roentgenogram of the lumbosacral angle and intervertebral space altitude were concerned to estimate the progress of the tuberculosis activity, bone graft fusion and states of the deformity correction between the preoperation and postoperation. The average lumbosacral angle of the preoperative was 18.6°(range 8.7°-27°) , the average intervertebral space altitude of the preoperative was 7.9mm. Results: The average operation time was 180 min (range 150-210 min). The average blood loss during the operation was 475 ml (range 400 - 550 ml). There were not the main vessel and nerve injury and serious complications in the operation. In this study, fourteen cases was excellent and two cases was good and the fineness rate was 100%, sixteen cases were all had definitive fusion. The average lumbosacral angle of the postoperative was 27.1°(range 16.5°-40.5°), and the average lumbosacral angle was 25.9°(range 16°-37.5°) at the late follow-up. The average intervertebral space of the postoperative was 10.6mm , the average altitude brace was 2.7mm to compare with the preoperation, the average intervertevral space height was 10.4mm at the late follow-up and the loss height smaller under 1.0mm. We found that it had the statistical significance between preoperative and postoperative as well as late follow-up (P < 0.05). Conclusion: One-stage posterior radical eradication, bone graft fusion and instrumentation in treatment of the lumbosacral tuberculosis is a feasible and an effective procedure in course of treatment. Posterior instrumentation can rebuild stability of the lumbosacrsal spine and it can be placed out of the focus of infection to prevent the tuberculosis infection to diffused.