Objective: To investigate the effectiveness of radical debridement, reconstruction with bone allograft, and pedicle screw-rod internal fixation via combined anterior and posterior approach in the treatment of lumbosacral tuberculosis.
Methods: Between January 2005 and May 2010, 16 patients with lumbosacral tuberculosis were treated. Radical debridement was performed via extraperitoneal approach, then tricortical iliac bone allograft was placed and pedicle screw-rod internal fixation was used to reconstruct the spinal column. There were 12 males and 4 females aged 38-65 years (mean, 48 years). The disease duration ranged from 6 to 24 months (mean, 10 months). The main clinical symptom was persistent pain in lumbosacral area. The involved segments included L4,5 (3 cases), L5, S1 (8 cases), and l-S1 (5 cases). The lumbosacral angle was 18-32 degrees (mean, 22 degrees). The erythrocyte sedimentation rate (ESR) was 15-55 mm/1 hour (mean, 25 mm/1 hour). All the patients were given antituberculosis chemotherapy for 12 months after operation.
Results: The operation time was 120-240 minutes (mean, 180 minutes). The amount of bleeding was 300-600 mL (mean, 420 mL). All wounds healed by first intention, and no relative complication occurred. All 16 cases were followed up 12-24 months (mean, 16 months). No recurrence occurred and ESR recovered to normal. Persistent pain in lumbosacral area and radicular pain in lower extremities disappeared. The X-ray films demonstrated that bony fusion was obtained in all patients at 8-12 months postoperatively. The lumbosacral angle was 16-31 degrees (mean, 21 degrees) at last follow-up.
Conclusion: The extraperitoneal approach can provide direct and safe access to the lesion. The structural iliac bone allograft and posterior instrumentation could reconstruct effectively the stability of the lumbosacral junction.