[Primary anterior focus debridement and bone autograft with internal fixation via transperitoneal approach for tuberculosis of lumbosacral junction].

OBJECTIVE

To evaluate the clinical outcomes of primary anterior focus debridement, bone autograft, and internal fixation via transperitoneal approach in treating tuberculosis of the lumbosacral junction.

METHODS

From February 2002 to April 2007, 16 patients with tuberculosis of the lumbosacral junction underwent anterior radical debridement, autologous iliac bone graft (two pieces of iliac bone, 5 cm x 3 cm in size), and internal fixation via transperitoneal approach, including 4 males and 12 females aged 27-63 years old (average 38 years old). The course of the disease ranged from 6 to 18 months (average 10 months). All patients experienced various degrees of pain in the lumbosacral area and toxic symptoms of the tuberculosis. Nine cases were complicated with radicular pain in the lower extremities, and 3 cases had saddle area anaesthesia. Two cases were initially diagnosed as lumbar intervertebral disc protrusion and treated accordingly. The segments involved by the tuberculosis were L5-S1 level in all cases. The average erythrocyte sedimentation rate (ESR) was 61 mm/hour. Imaging examination confirmed the diagnosis of spinal tuberculosis. All cases received four antitubercular drugs and nutrition support for nerve before operation. Operation was performed when hepatorenal function was normal, and the toxic symptom of the tuberculosis was under control or ESR was decreased.

RESULTS

Operation was performed safely in all cases without injuries of abdominal viscera, major blood vessel, cauda equina nerve and ureter. All wounds healed by first intention. No recurrence of tuberculosis and formation of sinuses occurred. All cases were followed up for 12-37 months (average 21 months). No such complications as tuberculous peritonitis and intestinal obstruction occurred. No postoperative erectile dysfunction and retrograde ejaculation occurred in the 4 male patients. ESR was recovered to normal 3-6 months after operation, and regular X-ray and CT exams showed no displacement of grafted bone. All patients achieved bony fusion 12 months after operation without the occurrence breakage and loosening of titanium plate and screw. The radical pain in the lower extremities and the saddle area anaesthesia disappeared. Four patients had pain in the iliac donor site, 2 patients had mild pain in the lumbosacral area, and the pain was eliminated after symptomatic treatment. The therapeutic effect was graded as excellent in 14 cases and good in 2 cases according to the therapeutic effect evaluation criteria of Chen and co-workers.

CONCLUSION

The surgical treatment of tuberculosis of the lumbosacral junction with primary anterior focus debridement, bone autograft, and internal fixation via transperitoneal approach can achieve satisfying bony fusion and reconstruct spinal stability.