ANTERIOR APPROACH DEBRIDEMENT AND BONE GRAFTING WITH SELF-LOCKED TITANIUM PLATE INTERNAL FIXATION FOR TREATING LUMBOSACRAL TUBERCULOSIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 LANJiaping ¹ , TANGXun ² , XUYongqing ² , WANGShuhong ³ , ZHANGZhi ¹ , ZHENGJiazhuang ¹ , WANGFandong ¹ , CHENYu ¹ , CAIQilin ¹ , RANMaobo ¹ , LIUYuanbin ¹

1. Department of Orthopaedics, Suining Central Hospital, Suining Sichuan, 629000, P. R. China;
2. Affiliated Orthopaedics Hospital, Trauma Orthopaedics Institute of Chinese PLA, Kunming General Hospital of Chengdu Military Command of Chinese PLA;
3. Department of Respiratory, Suining Central Hospital, Suining Sichuan, 629000, P. R. China;

Corresponding author：

LANJiaping, Email: 447839048@qq.com

Keywords：

Lumbosacral tuberculosis; Anterior approach; Autogenous bone; Bone grafting; Internal fixation

DOI：

10.7507/1002-1892.20160118

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Objective To explore the effectiveness of stage I anterior approach debridement and autologous iliac crest graft with single self-locked titanium plate internal fixation for the treatment of lumbosacral tuberculosis. Methods Seven cases of lumbosacral tuberculosis were treated by stage I anterior approach debridement, autologous iliac crest graft, and single self-locked titanium plate internal fixation between February 2010 and October 2014. There were 5 males and 2 females, aged 18-65 years (mean, 41.6 years). The disease duration was 5-21 months (mean, 8 months). The patients had signs and symptoms of pain in lumbosacral region, radiating pain in unilateral lower limb or bilateral lower limbs, decreased muscular strength and disorders of superficial sensation. According to Frankel classification for spinal injury, 1 case was rated as grade C, 3 cases as grade D, and 3 cases as grade E. Preoperative imaging examination suggested L₅, S₁ lesions in line with the manifestations of tuberculosis; the lumbosacral angle was 16.4-28.5° (mean, 18.6°). The erythrocyte sedimentation rate was 28-105 mm/1 hour (mean, 61 mm/1 hour). All patients received 4-drug antituberculosis therapy. Results All patients underwent the operation successfully and all incisions healed at stage I, without relevant complication. All patients were followed up 14-70 months (mean, 25.6 months). All symptoms of tuberculosis disappeared and the erythrocyte sedimentation rate returned to normal. At last follow-up, Frankel classification was returned to E from D in 3 cases, returned to D from C in 1 case. Two cases suffered from pains in the lumbosacral region and at the donor site, 1 case suffered from upper abdominal discomfort and poor appetite,but these symptoms disappeared after symptomatic treatment. At last follow-up, X-ray examination indicated that the lumbosacral angle was 23.4-34.2° (mean, 28.6°). According to Bridwell criteria, 5 cases gained grade I bone fusion, and 2 cases gained grade II bone fusion, without migration of bone graft, or loosening or breakage of titanium plate or bolt. Conclusion Stage I anterior approach debridement and autologous iliac crest graft with single self-locked titanium plate internal fixation is safe and effective in treating lumbosacral tuberculosis. It can achieve good bone fusion and stable lumbosacral stability, and maintain good deformity correction.

Citation： LANJiaping, TANGXun, XUYongqing, WANGShuhong, ZHANGZhi, ZHENGJiazhuang, WANGFandong, CHENYu, CAIQilin, RANMaobo, LIUYuanbin. ANTERIOR APPROACH DEBRIDEMENT AND BONE GRAFTING WITH SELF-LOCKED TITANIUM PLATE INTERNAL FIXATION FOR TREATING LUMBOSACRAL TUBERCULOSIS. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(5): 585-589. doi: 10.7507/1002-1892.20160118 Copy

1.	Kalra KP, Dhar SB, Shetty G, et al. Pedicle subtraction osteotomy for rigid post-tuberculous kyphosis. J Bone Joint Surg (Br), 2006, 88(7):925-927.
2.	Bridwell KH, Baldus C, Berven S, et al. Changes in radiographic and clinical outcomes with primary treatment adult spinal deformity surgeries from two years to three-to five-years follow-up. Spine (Phila Pa 1976), 2010, 35(20):1849-1854.
3.	Zengming X, Maolin H, Xinli Z, et al. Anterior transsternal approach for a lesion in the upper thoracic vertebral body. J Neurosurg Spine, 2010, 13(4):461-468.
4.	Choi KC, Ryu KS, Lee SH, et al. Biomechanical comparison of anterior lumbar interbody fusion:stand-alone interbody cage versus interbody cage with pedicle screw fixation-a finite element analysis. BMC Musculoskelet Disord, 2013, 14(4):1-9.
5.	Buyukbebeci O, Karakurum G, Guleç A, et al. Tuberculous osteomyelitis of the lumbosacral region:a spinal epidural abscess with presacral extension. Arch Orthop Trauma Surg, 2004, 124(5):346-348.
6.	Arora S, Sabat D, Mainil L, et al. The results of nonoperative treatment of craniovertebral junction tuberculosis:a review of twenty-six cases. J Bone Joint Surg (Am), 2011, 93(6):540-547.
7.	Dunn R, Zondagh I, Candy S. Spinal tuberculosis:magnetic resonance imaging and neurological impairment. Spine (Phila Pa 1976), 2011, 36(6):469-473.
8.	肖联平, 江毅, 田永刚, 等. 前路经腹腔一期病灶清除植骨融合内固定术治疗腰骶段脊柱结核. 中国修复重建外科杂志, 2009, 23(8):913-916.
9.	蓝旭, 许建中, 刘雪梅, 等. 前后联合入路病灶清除植骨融合内固定治疗腰骶椎结核. 中国修复重建外科杂志, 2011, 25(10):1176-1179.
10.	He Q, Xu J. Comparison between the antero-posterior and anterior approaches for treating L₅-S₁ vertebral tuberculosis. Int Orthop, 2012, 36(2):345-351.
11.	Barrey C, Ene B, Louis-Tisserand G, et al. Vascular anatomy in the lumbar spine investigated by three-dimensional computed tomography angiography:the concept of vascular window. World Neurosurg, 2012, 79(5-6):784-791.
12.	Luo F, Zhang ZH, Sun D, et al. One-stage anterior approach with arch plate to treat lumbosacral tuberculosis. Orthop Surg, 2015, 7(4):354-358.
13.	许建中, 张泽华, 周强, 等. 一期前路病灶清除植骨融合内固定治疗腰骶椎结核. 中国脊柱脊髓杂志, 2006, 16(12):897-900.
14.	Li JH, Zhang ZH, Shi T, et al. Surgical treatment of lumbosacral tuberculosis by one-stage debridement and anterior instrumentation with allograft through an extraperitoneal anterior approach. J Orthop Surg Res, 2015, 10(1):1-8.
15.	Ling T, Liu L, Yang X, et al. Revision surgery for spinal tuberculosis with secondary deformity after treatment with debridement, instrumentation, and fusion. Eur Spine J, 2015, 24(3):577-585.
16.	Ha KY, Chung YG, Ryoo SJ. Adherence and bilofilm formation of staphylococcus epidermidis and mycobacterium tuberculosis on various spinal impiants. Spine (Phila Pa 1976), 2005, 30(1):38-43.
17.	杨斌辉, 欧阳振, 赵金龙, 等. 前路Ⅰ期病灶清除加植骨融合内固定治疗腰骶段结核. 中国骨伤, 2013, 26(7):546-548.
18.	Arjmand B, Aghayan HR, Larijani B, et al. The effect of gamma irradiation on the osteoinductivity of demineralized human bone allograft. Acta Med Iran, 2014, 52(3):215-219.
19.	Luo C, Wang X, Wu P, et al. Single-stage transpedicular decompression, debridement, posterior instrumentation,and fusion for thoracic tuberculosis with kyphosis and spinal cord compression in aged individuals. Spine J, 2016, 16(2):154-162.
20.	Wang XT, Zhou CL, Xi CY, et al. Surgical treatment of cervicothoracic junction spinal tuberculosis via combined anterior and posterior approaches in children. Chin Med J (Engl), 2012, 125(8):1443-1447.
21.	Pu X, Zhou Q, He Q, et al. A posterior versus anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberclosis. Int Orthop, 2012, 36(2):307-313.

1. Kalra KP, Dhar SB, Shetty G, et al. Pedicle subtraction osteotomy for rigid post-tuberculous kyphosis. J Bone Joint Surg (Br), 2006, 88(7):925-927.
2. Bridwell KH, Baldus C, Berven S, et al. Changes in radiographic and clinical outcomes with primary treatment adult spinal deformity surgeries from two years to three-to five-years follow-up. Spine (Phila Pa 1976), 2010, 35(20):1849-1854.
3. Zengming X, Maolin H, Xinli Z, et al. Anterior transsternal approach for a lesion in the upper thoracic vertebral body. J Neurosurg Spine, 2010, 13(4):461-468.
4. Choi KC, Ryu KS, Lee SH, et al. Biomechanical comparison of anterior lumbar interbody fusion:stand-alone interbody cage versus interbody cage with pedicle screw fixation-a finite element analysis. BMC Musculoskelet Disord, 2013, 14(4):1-9.
5. Buyukbebeci O, Karakurum G, Guleç A, et al. Tuberculous osteomyelitis of the lumbosacral region:a spinal epidural abscess with presacral extension. Arch Orthop Trauma Surg, 2004, 124(5):346-348.
6. Arora S, Sabat D, Mainil L, et al. The results of nonoperative treatment of craniovertebral junction tuberculosis:a review of twenty-six cases. J Bone Joint Surg (Am), 2011, 93(6):540-547.
7. Dunn R, Zondagh I, Candy S. Spinal tuberculosis:magnetic resonance imaging and neurological impairment. Spine (Phila Pa 1976), 2011, 36(6):469-473.
8. 肖联平, 江毅, 田永刚, 等. 前路经腹腔一期病灶清除植骨融合内固定术治疗腰骶段脊柱结核. 中国修复重建外科杂志, 2009, 23(8):913-916.
9. 蓝旭, 许建中, 刘雪梅, 等. 前后联合入路病灶清除植骨融合内固定治疗腰骶椎结核. 中国修复重建外科杂志, 2011, 25(10):1176-1179.
10. He Q, Xu J. Comparison between the antero-posterior and anterior approaches for treating L₅-S₁ vertebral tuberculosis. Int Orthop, 2012, 36(2):345-351.
11. Barrey C, Ene B, Louis-Tisserand G, et al. Vascular anatomy in the lumbar spine investigated by three-dimensional computed tomography angiography:the concept of vascular window. World Neurosurg, 2012, 79(5-6):784-791.
12. Luo F, Zhang ZH, Sun D, et al. One-stage anterior approach with arch plate to treat lumbosacral tuberculosis. Orthop Surg, 2015, 7(4):354-358.
13. 许建中, 张泽华, 周强, 等. 一期前路病灶清除植骨融合内固定治疗腰骶椎结核. 中国脊柱脊髓杂志, 2006, 16(12):897-900.
14. Li JH, Zhang ZH, Shi T, et al. Surgical treatment of lumbosacral tuberculosis by one-stage debridement and anterior instrumentation with allograft through an extraperitoneal anterior approach. J Orthop Surg Res, 2015, 10(1):1-8.
15. Ling T, Liu L, Yang X, et al. Revision surgery for spinal tuberculosis with secondary deformity after treatment with debridement, instrumentation, and fusion. Eur Spine J, 2015, 24(3):577-585.
16. Ha KY, Chung YG, Ryoo SJ. Adherence and bilofilm formation of staphylococcus epidermidis and mycobacterium tuberculosis on various spinal impiants. Spine (Phila Pa 1976), 2005, 30(1):38-43.
17. 杨斌辉, 欧阳振, 赵金龙, 等. 前路Ⅰ期病灶清除加植骨融合内固定治疗腰骶段结核. 中国骨伤, 2013, 26(7):546-548.
18. Arjmand B, Aghayan HR, Larijani B, et al. The effect of gamma irradiation on the osteoinductivity of demineralized human bone allograft. Acta Med Iran, 2014, 52(3):215-219.
19. Luo C, Wang X, Wu P, et al. Single-stage transpedicular decompression, debridement, posterior instrumentation,and fusion for thoracic tuberculosis with kyphosis and spinal cord compression in aged individuals. Spine J, 2016, 16(2):154-162.
20. Wang XT, Zhou CL, Xi CY, et al. Surgical treatment of cervicothoracic junction spinal tuberculosis via combined anterior and posterior approaches in children. Chin Med J (Engl), 2012, 125(8):1443-1447.
21. Pu X, Zhou Q, He Q, et al. A posterior versus anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberclosis. Int Orthop, 2012, 36(2):307-313.

Chinese Journal of Reparative and Reconstructive Surgery

ANTERIOR APPROACH DEBRIDEMENT AND BONE GRAFTING WITH SELF-LOCKED TITANIUM PLATE INTERNAL FIXATION FOR TREATING LUMBOSACRAL TUBERCULOSIS

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