Unilateral Limited Laminectomy for Debridement to Treat Localized Short-Segment Lumbosacral Spinal Tuberculosis: A Retrospective Case Series.

OBJECTIVE

This study aimed to investigate the clinical effects of surgically treating lumbosacral tuberculosis with a modified posterior unilateral limited laminectomy method for debridement.

METHODS

This retrospective study enrolled a total of 26 patients who were administered in our institution from January 2010 to December 2016, diagnosed with lumbosacral tuberculosis at the L5/S1 level, and underwent one-stage posterior unilateral limited laminectomy as surgical treatment for debridement, allograft of cortical bone grafting, and fixation. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, visual analog scale (VAS) score, Oswestry Disability Index (ODI), and lumbosacral angle (LA, Cobb's method) were statistically compared, and the American Spinal Injury Association Impairment (ASIA) Scale was compared between the preoperative and postoperative time points to evaluate the clinical outcomes.

RESULTS

All 26 patients were observed during the follow-up period, and the mean follow-up time was 1.3 ± 0.42 years. The mean age was 56 ± 7.4 years old. The average operation time was 118.1 ± 17.5 min, and the mean bleeding volume was 513.0 ± 79.6 mL. There were no intraoperative complications or tuberculous sinus, and two cases experienced hypostatic pneumonia during hospitalization, which resolved with responsive antibiotics and symptomatic supportive treatment. At the final follow-up, there was no recurrence of tuberculosis, and the ESR (11.8 ± 1.8 mm/h) and CRP (3.0 ± 1.0 mg/L) levels in all patients had returned to normal. The patients with neurologic deficits had improved, and the mean ODI was 79.9 ± 10.6 (87-62) preoperatively and significantly decreased to 20.5 ± 5.7 (11-29) at the final follow-up (P < 0.01). ASIA scale scores were improved by 1~2 grades at the last follow-up. The patients' pain levels were significantly alleviated; the mean VAS score declined to 1.2 ± 0.4 (0-2.5) at the final follow-up compared to 7.5 ± 1.6 (6.5-8.5) preoperatively (P < 0.01). All patients achieved bony graft fusion at an average time of 6.8 ± 1.2 months. Physiological lumbar lordosis was significantly improved, and the mean LA before operation was 17.6° ± 2.1°, which was significantly different from the postoperative LA (29.3° ± 7.4°, P < 0.01) at the final follow up. The LA (27.1° ± 5.5°, P = 0.15) slightly rebounded but without significance compared to the postoperative level.

CONCLUSION

Only posterior approach by unilateral limited laminectomy for debridement could be served as an effective and safe method to treat short-segment lumbosacral tuberculosis without extensive anterior sacral and gravitation abscesses.