Single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation in surgical treatment for single-segment lumbar spinal tuberculosis

Abstract

Objective: The aim of this study is to determine the feasibility and efficacy of surgical management of single-segment lumbar spinal tuberculosis (TB) by using single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation.
Methods: Seventeen cases of single-segment lumbar TB were treated with single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation. The mean follow-up was 36.9 months (range: 24–62 months). The kyphotic angle ranged from 15.2–35.1° preoperatively, with an average measurement of 27.8°. The American Spinal Injury Association (ASIA) score system was used to evaluate the neurological deficits and erythrocyte sedimentation rate (ESR) used to judge the activity of TB.
Results: Spinal TB was completely cured in all 17 patients. There was no recurrent TB infection. The postoperative kyphotic angle was 6.6–10.2°, 8.1° in average, and there was no significant loss of the correction at final follow-up. Solid fusion was achieved in all cases. Neurological condition in all patients was improved after surgery.
Conclusion: Single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation can be a feasible and effective method the in treatment of single-segment lumbar spinal TB.

 

Keywords

• 3-column reconstruction; debridement; limited decompression; lumbar spinal TB; posterior transforaminal lumbar interbody fusion; single-segment.

References

1. Moon MS, Moon YW, Moon JL, Kim SS, Sun DH. Con- servative treatment of tuberculosis of the lumbar and lum- bosacral spine. Clin Orthop Relat Res 2002;398:40–9.
2. Dunn R, Zondagh I, Candy S. Spinal tuberculosis: magnet- ic resonance imaging and neurological impairment. Spine (Phila Pa 1976) 2011;36:469–73.
3. Faraj AA. Anterior instrumentation for the treatment of spi- nal tuberculosis. J Bone Joint Surg Am 2001;83-A:463–4.
4. Benli IT, Acaroglu E, Akalin S, Kis M, Duman E, Un A. Anterior radical debridement and anterior instrumenta- tion in tuberculosistuberculosis spondylitis. Eur Spine J 2003;12:224–34.
5. Ma YZ, Cui X, Li HW, Chen X, Cai XJ, Bai YB. Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults. Int Orthop 2012;36:299–305.
6. Wang XB, Li J, Lü GH, Wang B, Lu C, Kang YJ. Single- stage posterior instrumentation and anterior debridement for active tuberculosis of the thoracic and lumbar spine with kyphotic deformity. Int Orthop.2012;36:373–80.
7. Pang X, Shen X, Wu P, Luo C, Xu Z, Wang X. Thoraco- lumbar spinal tuberculosis with psoas abscesses treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage. Arch Orthop Trauma Surg 2013;133:765–72.
8. Zhang HQ, Lin MZ, Li JS, Tang MX, Guo CF, Wu JH, et al. One-stage posterior debridement, transforaminal lum- bar interbody fusion and instrumentation in treatment of lumbar spinal tuberculosis: a retrospective case series. Arch Orthop Trauma Surg 2013;133:333–41.

9. Zhang HQ, Li JS, Zhao SS, Shao YX, Liu SH, Gao Q, et al. Surgical management for thoracic spinal tuberculo- sis in the elderly: posterior only versus combined poste- rior and anterior approaches. Arch Orthop Trauma Surg 2012;132:1717–23.
10. Wang X, Pang X, Wu P, Luo C, Shen X. One-stage anterior debridement, bone grafting and posterior instrumentation vs. single posterior debridement, bone grafting, and instru- mentation for the treatment of thoracic and lumbar spinal tuberculosis. Eur Spine J 2014;23:830–7.
11. Pang X, Li D, Wang X, Shen X, Luo C, Xu Z, et al. Tho- racolumbar spinal tuberculosistuberculosis in children with severe post-tubercular kyphotic deformities treated by single-stage closing-opening wedge osteotomy: preliminary report a 4-year follow-up of 12 patients. Child’s Nerv Syst 2014;30:903–9.
12. Zhang XF, Wang Y, Xiao SH, Liu ZS, Zhang YG, Liu BW, et al. Treatment of lumbar and lumbosacral spinal tuberculosis with minimally invasive surgery. Orthop Surg 2010;2:64–70.
13. Meena S, Mittal S, Chowdhary B. Spinal tuberculo- sis: which is the best surgical approach? Med Princ Pract 2014;23:96.
14. Güven O, Bezer M, Aydin N, Ketenci IE. Treatment strat- egy in tuberculous spondylitis: long-term follow-up results of 55 patients. [Article in Turkish] Acta Orthop Traumatol Turc 2008;42:334–43.
15. Mehta JS, Bhojraj SY. Tuberculosis of the thoracic spine. A classification based on the selection of surgical strategies. J Bone Joint Surg Br 2001;83:859–63.
16. Garg B, Kandwal P, Nagaraja UB, Goswami A, Jayaswal A. Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis: A retrospective analysis. In- dian J Orthop 2012;46:165–70.
17. Dai LY, Jiang LS, Wang YR, Jiang SD. Chemotherapy in anterior instrumentation for spinal tuberculosis: high- lighting a 9-month three-drug regimen. World Neurosurg 2010;73:560–4.
18. Lee CK, Vessa P, Lee JK. Chronic disabling low back pain syndrome caused by internal disc derangements. The re- sults of disc excision and posterior lumbar interbody fusion. Spine (Phila Pa 1976) 1995;20:356–61.
19. Pu X, Zhou Q, He Q, Dai F, Xu J, Zhang Z, et al. A pos- terior versus anterior surgical approach in combination with debridement, interbody autografting and instrumen- tation for thoracic and lumbar tuberculosis. Int Orthop 2012;36:307–13.
20. Güzey FK, Emel E, Bas NS, Hacisalihoglu S, Seyithanoglu MH, Karacor SE, et al. Thoracic and lumbar tuberculous spondylitis treated by posterior debridement, graft place- ment, and instrumentation: a retrospective analysis in 19 cases. J Neurosurg Spine 2005;3:450–8.
21. Lee JS, Moon KP, Kim SJ, Suh KT. Posterior lumbar in- terbody fusion and posterior instrumentation in the surgi- cal management of lumbar tuberculous spondylitis. J Bone Joint Surg Br 2007;89:210–4.
22. Lee SH, Sung JK, Park YM. Single-stage transpedicular de- compression and posterior instrumentation in treatment of thoracic and thoracolumbar spinal tuberculosis: a retrospec- tive case series. J Spinal Disord Tech 2006;19:595–602.
23. Bokov A, Isrelov A, Skorodumov A, Aleynik A, Simonov A, Mlyavykh S. An analysis of reasons for failed back sur- gery syndrome and partial results after different types of surgical lumbar nerve root decompression. Pain Physician 2011;14:545–57.
24. Caspar W, Papavero L, Sayler MK, Harkey HL. Precise and limited decompression for lumbar spinal stenosis. Acta Neurochir (Wien) 1994;131:130–6.
25. Krämer R, Wild A, Haak H, Borowski S, Krauspe R. The effect of limited interlaminar decompression versus com- plete laminectomy on intrathecal volume in degenerative lumbar spinal stenosis. Biomed Tech (Berl) 2002;47:159– 63.
26. Aykaç B, Copuroğlu C, Ozcan M, Ciftdemir M, Yalnız E. Postoperative evaluation of quality of life in lumbar spinal stenosis patients following instrumented posterior decom- pression. Acta Orthop Traumatol Turc 2011;45:47–52.
27. Dahabreh Z, Calori GM, Kanakaris NK, Nikolaou VS, Giannoudis PV. A cost analysis of treatment of tibial frac- ture nonunion by bone grafting or bone morphogenetic pro- tein-7. Int Orthop 2009;33:1407–14.
28. Xie J, Li T, Wang Y, Zhao Z, Zhang Y, Bi N. Change in Cobb angle of each segment of the major curve after pos- terior vertebral column resection (PVCR): a preliminary discussion of correction mechanisms of PVCR. Eur Spine J 2012;21:705–10.
29. Hsu WH, Lui TN, Chang CN, Hsu YH, Lin CL, Yang DJ. Minimally invasive decompression with posterior column reinforcement for the treatment of symptomatic osteopo- rotic fracture with spinal stenosis in lumbar vertebrae. J Clin Neurosci 2011;18:1645–50.
30. Chandler K, Cappello R. Laminectomy membrane forma- tion in dogs: is the answer still elusive? Vet J.2006;172:1–2.
31. Hollingworth W, Turner JA, Welton NJ, Comstock BA, Deyo RA. Costs and cost-effectiveness of spinal cord stimu- lation (SCS) for failed back surgery syndrome: an observa- tional study in a workers’ compensation population. Spine (Phila Pa 1976) 2011;36:2076–83.
32. Gelalis ID, Arnaoutoglou C, Christoforou G, Lykissas MG, Batsilas I, Xenakis T. Prospective analysis of surgical out- comes in patients undergoing decompressive laminectomy and posterior instrumentation for degenerative lumbar spi- nal stenosis. Acta Orthop Traumatol Turc 2010;44:235–40.