title: One-stage posterior debridement, transforaminal lumbar interbody fusion and instrumentation in treatment of lumbar spinal tuberculosis: a retrospective case series.
abstract: OBJECTIVE
  The purpose of this study is to compare the clinical outcomes of surgical management by one-stage posterior debridement, transforaminal lumbar interbody fusion (TLIF) and instrumentation and combined posterior and anterior approaches for lumbar spinal tuberculosis, and determine the clinical effectiveness of the posterior only surgical treatment for lumbar spinal TB at the same time.
  
  
  METHODS
  Thirty-seven patients who suffered lumbar tuberculosis were treated by two different surgical procedures in our center from May 2004 to June 2012. All the cases were divided into two groups: 19 cases in Group A underwent one-stage posterior debridement, TLIF and instrumentation, and 18 cases in Group B underwent posterior instrumentation, anterior debridement and bone graft in a single-stage procedure. The operation time, blood loss, lumbar kyphotic angle, recovery of neurological function and fusion time were, respectively, compared between Group A and Group B.
  
  
  RESULTS
  The average follow-up period for Group A was 46.6 ± 16.7 months, and for Group B, 47.5 ± 15.0 months. It was obvious that the average operative duration and blood loss of Group A was less than those of Group B. Lumbar tuberculosis was completely cured and the grafted bones were fused in 10 months in all patients. There was no persistence or recurrence of infection and no differences in the radiological results in both groups. The kyphosis was significantly corrected after surgical management. The average pretreatment ESR was 60.7 ± 22.5 mm/h, which became normal (9.0 ± 2.8 mm/h) within 3 months in all patients.
  
  
  CONCLUSIONS
  Surgical management by one-stage posterior debridement, TLIF and instrumentation for lumbar tuberculosis is feasible and effective. This approach obtained better clinical outcomes than combined posterior and anterior surgeries.
authors.affiliation: Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, ChangSha, China. zhq9996@163.com
authors.forename: Hong-qi
authors.initials: HQ
authors.lastname: Zhang
authors.forename: Min-zhong
authors.initials: MZ
authors.lastname: Lin
authors.forename: Jin-song
authors.initials: JS
authors.lastname: Li
authors.forename: Ming-xing
authors.initials: MX
authors.lastname: Tang
authors.forename: Chao-feng
authors.initials: CF
authors.lastname: Guo
authors.forename: Jian-huang
authors.initials: JH
authors.lastname: Wu
authors.forename: Jin-yang
authors.initials: JY
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003646:Debridement; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation*; D014399:Tuberculosis, Spinal / Q000601:surgery*; D055815:Young Adult