title: [Debridement and allograft with internal fixation via combined anterior and posterior approach for treatment of lumbosacral tuberculosis].
abstract: OBJECTIVE
  To investigate the effectiveness of radical debridement, reconstruction with bone allograft, and pedicle screw-rod internal fixation via combined anterior and posterior approach in the treatment of lumbosacral tuberculosis.
  
  
  METHODS
  Between January 2005 and May 2010, 16 patients with lumbosacral tuberculosis were treated. Radical debridement was performed via extraperitoneal approach, then tricortical iliac bone allograft was placed and pedicle screw-rod internal fixation was used to reconstruct the spinal column. There were 12 males and 4 females aged 38-65 years (mean, 48 years). The disease duration ranged from 6 to 24 months (mean, 10 months). The main clinical symptom was persistent pain in lumbosacral area. The involved segments included L4,5 (3 cases), L5, S1 (8 cases), and l-S1 (5 cases). The lumbosacral angle was 18-32 degrees (mean, 22 degrees). The erythrocyte sedimentation rate (ESR) was 15-55 mm/1 hour (mean, 25 mm/1 hour). All the patients were given antituberculosis chemotherapy for 12 months after operation.
  
  
  RESULTS
  The operation time was 120-240 minutes (mean, 180 minutes). The amount of bleeding was 300-600 mL (mean, 420 mL). All wounds healed by first intention, and no relative complication occurred. All 16 cases were followed up 12-24 months (mean, 16 months). No recurrence occurred and ESR recovered to normal. Persistent pain in lumbosacral area and radicular pain in lower extremities disappeared. The X-ray films demonstrated that bony fusion was obtained in all patients at 8-12 months postoperatively. The lumbosacral angle was 16-31 degrees (mean, 21 degrees) at last follow-up.
  
  
  CONCLUSIONS
  The extraperitoneal approach can provide direct and safe access to the lesion. The structural iliac bone allograft and posterior instrumentation could reconstruct effectively the stability of the lumbosacral junction.
authors: Department of Spine Surgery, Lanzhou General Hospital, Lanzhou Command of Chinese PLA, Lanzhou Gansu 730050, PR China. Izzyjw@sina.com
authors: Xu
authors: X
authors: Lan
authors: Jianzhong
authors: J
authors: Xu
authors: Xuemei
authors: X
authors: Liu
authors: Baofeng
authors: B
authors: Ge
mesh_terms: D000328:Adult; D000368:Aged; D003646:Debridement; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008159:Lumbar Vertebrae; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion / Q000379:methods*; D014399:Tuberculosis, Spinal / Q000601:surgery*