title: Global Reconstruction for Extensive Destruction in Tuberculosis of the Lumbar Spine and Lumbosacral Junction: A Case Report.
abstract: Study Design Case report. Objective To analyze the surgical difficulties in restoring global spinal stability and to describe an effective surgical option for tuberculosis with extensive destruction of the lumbosacral spine. Advanced tuberculosis with destruction of the lumbosacral spine can result in a kyphosis or hypolordosis, leading to back pain, spinal instability, and neurological deficits. The conventional treatment goals of lumbosacral tuberculosis are to correct and prevent a lumbar kyphosis, treat or prevent a neurological deficit, and restore global spinal stability. Instrumentation at the lumbosacral junction is technically demanding due to the complex local anatomy, the unique biomechanics, and the difficult fixation in the surrounding diseased bone. Methods We report a 21-year-old woman with tuberculosis from L1 to S2 with back pain and spinal instability. The radiographs showed a kyphosis of the lumbar spine. The magnetic resonance imaging and computed tomography scans revealed extensive destruction of the lumbar and lumbosacral spine. Spinopelvic stabilization combined with anterior debridement and reconstruction with free fibular strut graft was performed. Results The radiographs at follow-up showed a good correction of the kyphosis and excellent graft incorporation and fusion. Conclusions Anterior column reconstruction with a fibular strut graft helps restore and maintain the vertebral height. Posterior stabilization with spinopelvic fixation can be an effective surgical option for reconstructing the spine in extensive lumbosacral tuberculosis with sacral body destruction, requiring long fusions to the sacrum. It augments spinal stability, prevents graft-related complications, and accelerates the graft incorporation and fusion, thereby permitting early mobilization and rehabilitation. In spinal tuberculosis, antitubercular therapy may have to be prolonged in cases with large disease load, based on the clinicoradiographic and laboratory parameters.
authors.affiliation: Spine Disorders Unit, Institute of Orthopaedics and Traumatology, Rajiv Gandhi Government General Hospital and Madras Medical College, Chennai-3, Tamilnadu, India.
authors.forename: Nalli R
authors.initials: NR
authors.lastname: Uvaraj
authors.affiliation: Department of Orthopaedics and Traumatology, Government Mohan Kumaramangalam Medical College and Superspeciality Hospital, Salem, Tamilnadu, India.
authors.forename: Aju
authors.initials: A
authors.lastname: Bosco
authors.affiliation: Department of Orthopaedics, Institute of Orthopaedics and Traumatology, Rajiv Gandhi Government General Hospital and Madras Medical College, Chennai-3, Tamilnadu, India.
authors.forename: Nalli R
authors.initials: NR
authors.lastname: Gopinath
keywords: fibular graft; lumbosacral junction; spinal stability; spinopelvic stabilization; tuberculosis