Anterior Debridement Via The Medial Side Of Rectus Abdominal Combined With Posterior Instrumentation For Lumbosacral Tuberculosis:a Comparative Review Of 31 Cases

Background/objective: To our knowledgeable,there is no report on comparing between anterior debridement through the medial side of rectus abdominal combined with posterior instrumentation(ARAP)and anterolateral approach associated with posterior fixation(ALP)for lumbosacral tuberculosis.The purpose of our study is to detemine the safety and efficacy of ARAP by comparing with ALP.Methods: We retrospectively analyzed 31 cases with lumbosacral tuberculosis(L4/L5,L5/S1,L4-S1)treated with one of two surgical methods in our center from February 2012 to August 2018.According to the surgical methods,13 patient performed with ARAP were classified as group A and 18 treated with ALP as group B.Clinical,radiographic and follow-up data were collected from and compared between above two groups.Result: Average operative time,blood loss and length of stay for group ARAP and ALP were 193.55±70.58 min vs 210.75±51.57min(P=0.526),711.11±354.2ml vs 650.00±354.14ml(P=0.779)and 8±2.43 d vs 13 ±4.62d(P=0.069)respectively,with no difference between two groups.Howerver,postoperative lumbo-sacral angle was significantly improved compared with the preoperative angle in both two groups.The erythrocyte sedimentation rates(ESR),visual analogue scale(VAS),and Oswestry Disability Index(ODI)scores decreased significantly from the preoperative levels at last follow-up.One patient suffered from peritoneal rupture in group ARAP and patient devoloped into recurrence of tuberculosis.There were no Serious complications such retrograde ejaculation and ureteral injury.However,Iliac vascular injury occurred in 1 case in each group and vessel repairment was performed.One patient in group A sufferred from peritoneal tear and a repair procedure was conducted.One patient developed into recurrence in group B who was healed after a second debridement.Conclusion: Anterior debridement through the medial side of rectus abdominal combined with posterior instrumentation is a effective and safe treatment method for lumbosacral tuberculosis.