Clin Orthop Surg.  2016 Sep;8(3):268-273. 10.4055/cios.2016.8.3.268.

Evaluation of Outcome of Posterior Decompression and Instrumented Fusion in Lumbar and Lumbosacral Tuberculosis

• Jain A
• Jain R
• Kiyawat V

• KMID: 2374272
• DOI: http://doi.org/10.4055/cios.2016.8.3.268

Abstract

BACKGROUND
For surgical treatment of lumbar and lumbosacral tuberculosis, the anterior approach has been the most popular approach because it allows direct access to the infected tissue, thereby providing good decompression. However, anterior fixation is not strong, and graft failure and loss of correction are frequent complications. The posterior approach allows circumferential decompression of neural elements along with three-column fixation attained via pedicle screws by the same approach. The purpose of this study was to evaluate the outcome (functional, neurological, and radiological) in patients with lumbar and lumbosacral tuberculosis operated through the posterior approach.
METHODS
Twenty-eight patients were diagnosed with tuberculosis of the lumbar and lumbosacral region from August 2012 to August 2013. Of these, 13 patients had progressive neurological deterioration or increasing back pain despite conservative measures and underwent posterior decompression and pedicle screw fixation with posterolateral fusion. Antitubercular therapy was given till signs of radiological healing were evident (9 to 16 months). Functional outcome (visual analogue scale [VAS] score for back pain), neurological recovery (Frankel grading), and radiological improvement were evaluated preoperatively, immediately postoperatively and 3 months, 6 months, and 1 year postoperatively.
RESULTS
The mean VAS score for back pain improved from 7.89 (range, 9 to 7) preoperatively to 2.2 (range, 3 to 1) at 1-year follow-up. Frankel grading was grade B in 3, grade C in 7, and grade D in 3 patients preoperatively, which improved to grade D in 7 and grade E in 6 patients at the last follow-up. Radiological healing was evident in the form of reappearance of trabeculae formation, resolution of pus, fatty marrow replacement, and bony fusion in all patients. The mean correction of segmental kyphosis was 9.85° postoperatively. The mean loss of correction at final follow-up was 3.15°.
CONCLUSIONS
Posterior decompression with instrumented fusion is a safe and effective approach for management of patients with lumbar and lumbosacral tuberculosis.

Keyword

Lumbosacral; Spinal tuberculosis; Posterior decompression

MeSH Terms

Adult
Back Pain
Cohort Studies
*Decompression, Surgical/adverse effects/methods/statistics & numerical data
Female
Humans
Lumbosacral Region/*surgery
Male
Middle Aged
Pain Measurement
Postoperative Complications
*Spinal Fusion/adverse effects/methods/statistics & numerical data
Tuberculosis, Spinal/*surgery
Young Adult

Figure

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  Fig. 1 (A) Preoperative sagittal T2-weighted magnetic resonance imaging scan showing L4–L5 spondylodiscitis with epidural soft tissue compressing the cauda equina. (B) Follow-up sagittal T2-weighted magnetic resonance imaging scan obtained at 1-year after surgery showing radiological healing (disappearance of soft tissue and fatty marrow conversion).

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  Fig. 2 (A) Preoperative plain radiograph showing destruction of L4 body and end plate with reduction of L3–L4 disc space and segmental kyphosis of 23°. (B) Follow-up radiograph at 1-year after surgery showing sclerosis at the affected level and pedicle screws with segmental kyphosis of 14°.

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