Orthopaedic Department, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Orthopaedic Department, Hospital of Chengdu, Office of People's Government of Tibetan Autonomous Region, Chengdu, People's Republic of China.
World Neurosurg. 2021 Apr;148:e10-e16. doi: 10.1016/j.wneu.2020.11.104. Epub 2020 Nov 27.
Treatment of lumbosacral tuberculosis is still controversial. In our study, we assessed the efficacy and feasibility of single-stage posterior debridement, interbody fusion using a structural autograft combined with a titanium mesh cage, and posterior instrumentation for the treatment of lumbosacral tuberculosis with significant vertebral body loss.
From May 2011 to June 2018, 15 patients with lumbosacral tuberculosis with significant vertebral body loss had undergone single-stage posterior debridement, interbody fusion using a structural autograft combined with a titanium mesh cage, and posterior instrumentation. The pre- and postoperative lumbosacral angle, visual analog scale score, erythrocyte sedimentation rate, C-reactive protein, and neurological status were assessed.
Surgery was successful for all patients, and no patient experienced tuberculosis recurrence during an average follow-up period of 27.3 months (range, 12-60 months). After surgery, the erythrocyte sedimentation rate and C-reactive protein for all patients had returned to normal within 3 months. At the final follow-up examination, the neurological status had improved in all patients who had had neurological deficits preoperatively. The mean preoperative lumbosacral angle was 12.6° (range, 6.7°-17.9°), and had increased to 27.7° (range, 24.3°-34.6°) after surgery. The average lumbosacral angle was 26.4° (range, 22.1°-32.3°), with an average loss of 1.4° (range, 0.6°-2.3°) at the final follow-up visit.
The combination of single-stage posterior debridement, interbody fusion using structural autografts with a titanium mesh cage, and posterior instrumentation is an effective and safe option for the treatment of lumbosacral tuberculosis with significant vertebral body loss.
腰骶结核的治疗仍存在争议。在本研究中，我们评估了一期后路清创、结构性自体骨与钛网 cage 椎间融合及后路内固定治疗严重椎体骨质破坏的腰骶结核的疗效和可行性。
2011 年 5 月至 2018 年 6 月，15 例严重椎体骨质破坏的腰骶结核患者接受了一期后路清创、结构性自体骨与钛网 cage 椎间融合及后路内固定治疗。评估术前和术后腰骶角、视觉模拟评分、红细胞沉降率、C 反应蛋白和神经状态。
所有患者手术均成功，平均随访 27.3 个月（12-60 个月）期间无 1 例患者结核病复发。术后所有患者红细胞沉降率和 C 反应蛋白均在 3 个月内恢复正常。末次随访时，所有术前有神经功能障碍的患者神经功能均有改善。术前腰骶角平均为 12.6°（6.7°-17.9°），术后增加至 27.7°（24.3°-34.6°）。平均腰骶角为 26.4°（22.1°-32.3°），末次随访时平均丢失 1.4°（0.6°-2.3°）。
一期后路清创、结构性自体骨与钛网 cage 椎间融合及后路内固定是治疗严重椎体骨质破坏的腰骶结核的有效、安全方法。
