Surgical treatment of lumbar tuberculous spondylodiscitis by transforaminal lumbar interbody fusion (TLIF) and posterior instrumentation.

STUDY DESIGN

Retrospective case study.

OBJECTIVE

We present a retrospective clinical study of 15 patients with lumbar and lumbosacral tuberculosis treated by transforaminal lumbar interbody fusion and posterior instrumentation. The purpose is to determine the clinical efficacy of such surgical treatment for lumbar tuberculosis.

SUMMARY OF BACKGROUND DATA

The goals of management of tuberculous spondylodiscitis are to eradicate infection and to prevent or treat deformity, instability, and neurologic deficit. Various methods of surgical debridement and fusion have been described for the lumbar spine. However, there have been few reports on the treatment of patients with peridiscal type of lumbar tuberculosis by transforaminal debridement and interbody fusion along with posterior stabilization using pedicle screw fixation.

METHODS

Our study comprises 9 males and 6 females with an average age of 47 years treated with the above given surgical procedure. All patients had single motion segment involvement. The average follow-up is 41 months. We have evaluated the following parameters: healing of disease, deformity correction and its maintenance, improvement in neurology, fusion of affected segment, and functional outcome.

RESULTS

The mean preoperative local lordotic angle of -3.7 degrees was corrected surgically to a mean of 5 degrees immediately postoperatively. The mean local lordosis at final follow-up (mean 41 mo, 26 to 69 mo) was 4 degrees. Using the modified radiologic criteria of Lee et al, we found that 13 patients had definitive fusion and 2 patients had probable fusion. All patients had healing of disease and there was no recurrence at final follow-up. Using the criteria of Kirkaldy-Willis et al, the functional outcome was found to be excellent in 8, good in 5, and fair in 2 patients.

CONCLUSIONS

Transforaminal lumbar interbody fusion with pedicle screw fixation is a simple, safe, and effective procedure for treatment of selected patients suffering from lumbar and lumbosacral tuberculosis.