Treatment of lumbar and lumbosacral spinal tuberculosis with minimally invasive surgery.
OBJECTIVE
To evaluate the outcome of computed tomography (CT)-guided percutaneous puncture and local chemotherapy for tuberculosis (TB) of the lumbar or lumbosacral spine.


METHODS
From January 2002 to August 2006, 49 patients with lumbar or lumbosacral spinal TB in whom conservative treatment had failed were treated by minimally invasive surgery. There were 21 female and 28 male patients. The mean age of the patients was 47 ± 18 years (range from 12 to 78 years). There were 40 cases with lumbar TB, and 9 with lumbosacral TB. From L(1) to S(1), the involved vertebral numbers were 8, 26, 19, 19, 21 and 10, respectively. In 3 patients the spinal TB involved a single vertebra, in 39 patients two, in 6 patients three and in only one case four vertebrae. According to the Frankel scale, three patients had grade E incomplete paralysis preoperatively. The outcome, after treatment by CT-guided percutaneous puncture and local chemotherapy, was retrospectively analyzed according to the preoperative and postoperative kyphotic angles and the Oswestry disability index (ODI).


RESULTS
Forty-nine patients were followed up for from one year to 5 years and 8 months (average 35 months). All cases recovered, and there was no recurrence. Preoperatively, the kyphotic angle was 16.47°± 8.74°, and it had decreased to 13.35°± 8.02° by the final follow-up (t= 5.79, P < 0.001). The average ODI score had improved from 70.12 ± 22.24 to 12.72 ± 8.62 (t= 21.42, P < 0.001).


CONCLUSIONS
The majority of cases of lumbar and lumbosacral spinal TB can achieve satisfactory results with minimally invasive surgery. Its clinical application is therefore strongly recommended.
Special Hospital of Orthopaedics, The General Hospital of the People's Liberation Army (PLA), Beijing, China. xifengzhang301@yahoo.com.cn
Xi-feng
XF
Zhang
Yan
Y
Wang
Shong-hua
SH
Xiao
Zheng-sheng
ZS
Liu
Yong-gang
YG
Zhang
Bao-wei
BW
Liu
Zhi-min
ZM
Xia
D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery; D013129:Spinal Puncture / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D055815:Young Adult
D000995:Antitubercular Agents