Surgical treatment of lower lumbar tuberculosis with different operative procedures

Objective:To evaluate the surgical indications and clinical effectiveness of different operative procedures in the treatment of lower lumbar tuberculosis.Methods:From June 2001 to Oct 2008,72 patients with lower lumbar tuberculosis were treated by different operative procedures.Including 38 males and 34 females,with an average age of 38.5 years old ranging from 16 to 70 years.The average duration of symptom was 6.8 months(ranging from 4 months to 2 years).A single vertebrae was involved in 10 patients,two contiguous vertebrae in 50 cases and three vertebrae in 12 cases.The average preoperative lordotic angle was 13.1 degree(ranging from-5.0° to 34.0°).Three different operative procedures included:(1) posterior debridement and posterolateral fusion and posterior instrumentation in 28 patients;(2)anterior radical debridement and anterior fusion and anterior instrumentation in 32 patients;(3) image guided percutaneous drainage(PCD) of tuberculous abscesses in 12 patients.The selection of the procedure was made according to the degree of the lesions.The resolution of inflammatory process,bony fusion,correction of sagittal angles and JOA scores were used for evaluating the result of the surgery and the complications were analyzed.Results:All patients were followed up from 1.5 to 8.0 years(means 3.6 years).PCD was an effective treatment in 11 out of the 12 patients,one required surgical debridement and fusion.Among them,57(95%,57/60) patients were treated by open operation showed successful bony fusion.The complications maily included common iliac vein jnjury in 3 patients,dural tear in 2 patients,they were all cuerd by intro or postoprative treatment.The average immediate postoperative lordotic angle was 27.3 degree(35.0° to 16.0°),the average lordotic angle was 25.6 degree(33.0° to 15.0°) at final follow up.Preoperatively and at final follow up,JOA scores were respectively(15.2±3.4),(25.6±2.4)(P0.01).Conclusion:Different operative procedures should be selected to treat lower lumbar tuberculosis according to the degree of lesions.Aggressive surgical treatment was found helpful in the resolution of inflammatory process and correcting the loss of lordosis,preventing progression of kyphosis.