Treatment of Severe Bone Destruction in L5-S1 Spinal Tuberculosis With Anterior Combined Posterior Approach

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Abstract Background: There are many studies on the surgical treatment of lumbosacral tuberculosis, but both the anterior and posterior approaches present some shortcomings. This study aimed to evaluate the therapeutic efficacy of anterior debridement and bone graft, posterior fixation and fusion with navigation for L5-S1 tuberculosis with severe bone destruction. Methods: This was a retrospective study of 24 patients with severe tuberculosis in L5-S1 who underwent anterior interbody arthrodesis and posterior pedicle screw internal fixation by open approach under computer navigation between February 2011 and Novenmber 2016. The erythrocyte sedimentation rate(ESR), C-reactive protein level(CRP),visual analogue scale(VAS), and lumbosacral angle were compared between before surgery, after surgery, and at the final follow-up. The fusion status of bone graft was evaluated with computed tomography(CT).Results: The mean operation time was 244.58 minutes. The mean intraoperative blood loss was 413.75ml. The accuracy of screw placement was 96.43%. The mean follow-up period was 26.17 months. The average ESR, CRP, VAS, and lumbosacral angles were 65.96 mm/h, 52.93 mg/L, 4.96 points ,and 107.94°, respectively,at preoperative, 34.17 mm/h, 16.47 mg/L, 1.58 points, and 116.12°, respectively, after surgery, and 14.08 mm/h, 6.20 mg/L, 0.58 points, and 115.97°, respectively, at the final follow-up period. The differences of ESR, CRP, VAS are statistically significant (p < 0.05). The difference of lumbosacral angles before and after surgery is statistically significant (p < 0.05)，but there is no statistically significant difference between after surgery and the final follow-up period (p＞0.05). Nine patients with ASIA Grade D before surgery returned to Grade E by the final follow-up period. All patients achieved bone fusion.There was no recurrence of the disease. Conclusions: Anterior debridement and bone graft fusion combined with navigated posterior pedicle screw fixation is a safe and effective treatment option for patients with severe bone destruction in L5-S1 spinal tuberculosis.

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