Skip to main content
Erschienen in: European Spine Journal 8/2015

01.08.2015 | Original Article

One-stage lumbopelvic fixation in the treatment of lumbosacral junction tuberculosis

verfasst von: Zhengquan Xu, Xiyang Wang, Xiongjie Shen, Chengke Luo, Ping Wu, Hao Zeng

Erschienen in: European Spine Journal | Ausgabe 8/2015

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To investigate the clinical efficacy and feasibility of surgical treatment for lumbosacral junction tuberculosis by one-stage posterior debridement, interbody fusion, lumbopelvic fixation, and postural drainage.

Methods

A total of 15 cases with lumbosacral junction tuberculosis treated by one-stage posterior debridement, interbody fusion, lumbopelvic fixation, and postural drainage in our center from January 2005 to October 2011 were studied. Lumbosacral angle, visual analog scale (VAS), and neurological performance were assessed before and after surgery.

Results

All patients were followed for 28–56 months post-operation (average, 40.7 ± 7.7 months). No severe complications occurred. Bone fusion occurred in all patients at a mean of 8.4 months (range 6–12 months) after surgery. The mean lumbosacral angle was significantly increased from the mean preoperative angle (20.9° ± 1.8°) both post-operatively (26.5° ± 1.6°) and at final follow-up (25.3° ± 1.4°) (both P < 0.05). All patients had significant post-operative improvement in neurological performance and VAS scores.

Conclusions

Our results suggest that one-stage posterior debridement, interbody fusion, lumbopelvic fixation, and postural drainage can be an effective and feasible treatment option for lumbosacral junction tuberculosis, offering fewer complications and a better quality of life.
Literatur
1.
Zurück zum Zitat Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR (2009) Epidemiology of extrapulmonary tuberculosis in the United States, 1993–2006. Clin Infect Dis 49:1350–1357PubMedCrossRef Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR (2009) Epidemiology of extrapulmonary tuberculosis in the United States, 1993–2006. Clin Infect Dis 49:1350–1357PubMedCrossRef
2.
Zurück zum Zitat Garcia-Rodriguez JF, Alvarez-Diaz H, Lorenzo-Garcia MV, Marino-Callejo A, Fernandez-Rial A, Sesma-Sanchez P (2011) Extrapulmonary tuberculosis: epidemiology and risk factors. Enferm Infec Microbiol Clin 29:502–509CrossRef Garcia-Rodriguez JF, Alvarez-Diaz H, Lorenzo-Garcia MV, Marino-Callejo A, Fernandez-Rial A, Sesma-Sanchez P (2011) Extrapulmonary tuberculosis: epidemiology and risk factors. Enferm Infec Microbiol Clin 29:502–509CrossRef
3.
Zurück zum Zitat Moon MS, Moon YW, Moon JL, Kim SS, Sun DH (2002) Conservative treatment of tuberculosis of the lumbar and lumbosacral spine. Clin Orthop Relat Res 398:40–49PubMedCrossRef Moon MS, Moon YW, Moon JL, Kim SS, Sun DH (2002) Conservative treatment of tuberculosis of the lumbar and lumbosacral spine. Clin Orthop Relat Res 398:40–49PubMedCrossRef
4.
Zurück zum Zitat Klockner C, Valencia R (2003) Sagittal alignment after anterior debridement and fusion with or without additional posterior instrumentation in the treatment of pyogenic and tuberculous spondylodiscitis. Spine (Phila Pa 1976) 28:1036–1042 Klockner C, Valencia R (2003) Sagittal alignment after anterior debridement and fusion with or without additional posterior instrumentation in the treatment of pyogenic and tuberculous spondylodiscitis. Spine (Phila Pa 1976) 28:1036–1042
5.
Zurück zum Zitat Bezer M, Kucukdurmaz F, Aydin N, Kocaoglu B, Guven O (2005) Tuberculous spondylitis of the lumbosacral region: long-term follow-up of patients treated by chemotherapy, transpedicular drainage, posterior instrumentation, and fusion. J Spinal Disord Tech 18:425–429PubMedCrossRef Bezer M, Kucukdurmaz F, Aydin N, Kocaoglu B, Guven O (2005) Tuberculous spondylitis of the lumbosacral region: long-term follow-up of patients treated by chemotherapy, transpedicular drainage, posterior instrumentation, and fusion. J Spinal Disord Tech 18:425–429PubMedCrossRef
6.
Zurück zum Zitat Zaveri GR, Mehta SS (2009) Surgical treatment of lumbar tuberculous spondylodiscitis by transforaminal lumbar interbody fusion (TLIF) and posterior instrumentation. J Spinal Disord Tech 22:257–262PubMedCrossRef Zaveri GR, Mehta SS (2009) Surgical treatment of lumbar tuberculous spondylodiscitis by transforaminal lumbar interbody fusion (TLIF) and posterior instrumentation. J Spinal Disord Tech 22:257–262PubMedCrossRef
7.
Zurück zum Zitat Arora S, Kumar R, Batra S, Nath R (2011) Transpedicular drainage of presacral abscess and posterior decompression of acute cauda equina syndrome in caries spine: a case series of 3 patients. J Spinal Disord Tech 24:E26–E30PubMedCrossRef Arora S, Kumar R, Batra S, Nath R (2011) Transpedicular drainage of presacral abscess and posterior decompression of acute cauda equina syndrome in caries spine: a case series of 3 patients. J Spinal Disord Tech 24:E26–E30PubMedCrossRef
8.
Zurück zum Zitat He Q, Xu J (2012) Comparison between the antero-posterior and anterior approaches for treating L5–S1 vertebral tuberculosis. Int Orthop 36:345–351PubMedCentralPubMedCrossRef He Q, Xu J (2012) Comparison between the antero-posterior and anterior approaches for treating L5–S1 vertebral tuberculosis. Int Orthop 36:345–351PubMedCentralPubMedCrossRef
9.
Zurück zum Zitat Shah SP, Kulkarni AG (2012) S1 tuberculosis treated with segmental lumbopelvic fixation: a case report. Spine (Phila Pa 1976) 37:E866–E869CrossRef Shah SP, Kulkarni AG (2012) S1 tuberculosis treated with segmental lumbopelvic fixation: a case report. Spine (Phila Pa 1976) 37:E866–E869CrossRef
10.
Zurück zum Zitat Lee CK, Vessa P, Lee JK (1995) Chronic disabling low back pain syndrome caused by internal disc derangements. The results of disc excision and posterior lumbar interbody fusion. Spine (Phila Pa 1976) 20:356–361CrossRef Lee CK, Vessa P, Lee JK (1995) Chronic disabling low back pain syndrome caused by internal disc derangements. The results of disc excision and posterior lumbar interbody fusion. Spine (Phila Pa 1976) 20:356–361CrossRef
11.
Zurück zum Zitat Pun WK, Chow SP, Luk KD, Cheng CL, Hsu LC, Leong JC (1990) Tuberculosis of the lumbosacral junction. Long-term follow-up of 26 cases. J Bone Joint Surg Br 72:675–678PubMed Pun WK, Chow SP, Luk KD, Cheng CL, Hsu LC, Leong JC (1990) Tuberculosis of the lumbosacral junction. Long-term follow-up of 26 cases. J Bone Joint Surg Br 72:675–678PubMed
12.
Zurück zum Zitat Bhojraj S, Nene A (2002) Lumbar and lumbosacral tuberculous spondylodiscitis in adults. Redefining the indications for surgery. J Bone Joint Surg Br 84:530–534PubMedCrossRef Bhojraj S, Nene A (2002) Lumbar and lumbosacral tuberculous spondylodiscitis in adults. Redefining the indications for surgery. J Bone Joint Surg Br 84:530–534PubMedCrossRef
13.
Zurück zum Zitat Song JF, Jing ZZ, Chen B, Ai ZS, Hu W (2012) One-stage anterolateral surgical treatment for lumbosacral segment tuberculosis. Int Orthop 36:339–344PubMedCentralPubMedCrossRef Song JF, Jing ZZ, Chen B, Ai ZS, Hu W (2012) One-stage anterolateral surgical treatment for lumbosacral segment tuberculosis. Int Orthop 36:339–344PubMedCentralPubMedCrossRef
14.
Zurück zum Zitat Jenkins DH, Hodgson AR, Yau AC, Dwyer AP, O’Mahoney G (1975) Stablization of the spine in the surgical treatment of severe spinal tuberculosis in children. Clin Orthop Relat Res 110:69–80PubMedCrossRef Jenkins DH, Hodgson AR, Yau AC, Dwyer AP, O’Mahoney G (1975) Stablization of the spine in the surgical treatment of severe spinal tuberculosis in children. Clin Orthop Relat Res 110:69–80PubMedCrossRef
15.
Zurück zum Zitat Moon MS, Woo YK, Lee KS, Ha KY, Kim SS, Sun DH (1995) Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spines. Spine (Phila Pa 1976) 20:1910–1916CrossRef Moon MS, Woo YK, Lee KS, Ha KY, Kim SS, Sun DH (1995) Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spines. Spine (Phila Pa 1976) 20:1910–1916CrossRef
16.
Zurück zum Zitat Sun L, Song Y, Liu L, Gong Q, Zhou C (2013) One-stage posterior surgical treatment for lumbosacral tuberculosis with major vertebral body loss and kyphosis. Orthopedics 36:e1082–e1090PubMedCrossRef Sun L, Song Y, Liu L, Gong Q, Zhou C (2013) One-stage posterior surgical treatment for lumbosacral tuberculosis with major vertebral body loss and kyphosis. Orthopedics 36:e1082–e1090PubMedCrossRef
17.
Zurück zum Zitat Ferrara LA, Gordon I, Coquillette M, Milks R, Fleischman AJ, Roy S, Goel VK, Benzel EC (2007) A preliminary biomechanical evaluation in a simulated spinal fusion model. Laboratory investigation. J Neurosurg Spine 7:542–548PubMedCrossRef Ferrara LA, Gordon I, Coquillette M, Milks R, Fleischman AJ, Roy S, Goel VK, Benzel EC (2007) A preliminary biomechanical evaluation in a simulated spinal fusion model. Laboratory investigation. J Neurosurg Spine 7:542–548PubMedCrossRef
18.
Zurück zum Zitat Flierl MA, Beauchamp KM, Bolles GE, Moore EE, Stahel PF (2009) Fatal outcome after insufficient spine fixation for pyogenic thoracic spondylodiscitis: an imperative for 360 degrees fusion of the infected spine. Patient Saf Surg 3:4PubMedCentralPubMedCrossRef Flierl MA, Beauchamp KM, Bolles GE, Moore EE, Stahel PF (2009) Fatal outcome after insufficient spine fixation for pyogenic thoracic spondylodiscitis: an imperative for 360 degrees fusion of the infected spine. Patient Saf Surg 3:4PubMedCentralPubMedCrossRef
19.
Zurück zum Zitat Kuklo TR, Bridwell KH, Lewis SJ, Baldus C, Blanke K, Iffrig TM, Lenke LG (2001) Minimum 2-year analysis of sacropelvic fixation and L5–S1 fusion using S1 and iliac screws. Spine (Phila Pa 1976) 26:1976–1983CrossRef Kuklo TR, Bridwell KH, Lewis SJ, Baldus C, Blanke K, Iffrig TM, Lenke LG (2001) Minimum 2-year analysis of sacropelvic fixation and L5–S1 fusion using S1 and iliac screws. Spine (Phila Pa 1976) 26:1976–1983CrossRef
20.
Zurück zum Zitat Schwend RM, Sluyters R, Najdzionek J (2003) The pylon concept of pelvic anchorage for spinal instrumentation in the human cadaver. Spine (Phila Pa 1976) 28:542–547 Schwend RM, Sluyters R, Najdzionek J (2003) The pylon concept of pelvic anchorage for spinal instrumentation in the human cadaver. Spine (Phila Pa 1976) 28:542–547
21.
Zurück zum Zitat Zheng ZM, Yu BS, Chen H, Aladin DM, Zhang KB, Zhang JF, Liu H, Luk KD, Lu WW (2009) Effect of iliac screw insertion depth on the stability and strength of lumbo-iliac fixation constructs: an anatomical and biomechanical study. Spine (Phila Pa 1976) 34:E565–E572CrossRef Zheng ZM, Yu BS, Chen H, Aladin DM, Zhang KB, Zhang JF, Liu H, Luk KD, Lu WW (2009) Effect of iliac screw insertion depth on the stability and strength of lumbo-iliac fixation constructs: an anatomical and biomechanical study. Spine (Phila Pa 1976) 34:E565–E572CrossRef
22.
23.
Zurück zum Zitat Bellabarba C, Schildhauer TA, Vaccaro AR, Chapman JR (2006) Complications associated with surgical stabilization of high-grade sacral fracture dislocations with spino-pelvic instability. Spine (Phila Pa 1976) 31:S80–S88 (S104)CrossRef Bellabarba C, Schildhauer TA, Vaccaro AR, Chapman JR (2006) Complications associated with surgical stabilization of high-grade sacral fracture dislocations with spino-pelvic instability. Spine (Phila Pa 1976) 31:S80–S88 (S104)CrossRef
24.
Zurück zum Zitat Lee SH, Sung JK, Park YM (2006) Single-stage transpedicular decompression and posterior instrumentation in treatment of thoracic and thoracolumbar spinal tuberculosis: a retrospective case series. J Spinal Disord Tech 19:595–602PubMedCrossRef Lee SH, Sung JK, Park YM (2006) Single-stage transpedicular decompression and posterior instrumentation in treatment of thoracic and thoracolumbar spinal tuberculosis: a retrospective case series. J Spinal Disord Tech 19:595–602PubMedCrossRef
25.
Zurück zum Zitat Guzey FK, Emel E, Bas NS, Hacisalihoglu S, Seyithanoglu MH, Karacor SE, Ozkan N, Alatas I, Sel B (2005) Thoracic and lumbar tuberculous spondylitis treated by posterior debridement, graft placement, and instrumentation: a retrospective analysis in 19 cases. J Neurosurg Spine 3:450–458PubMedCrossRef Guzey FK, Emel E, Bas NS, Hacisalihoglu S, Seyithanoglu MH, Karacor SE, Ozkan N, Alatas I, Sel B (2005) Thoracic and lumbar tuberculous spondylitis treated by posterior debridement, graft placement, and instrumentation: a retrospective analysis in 19 cases. J Neurosurg Spine 3:450–458PubMedCrossRef
26.
Zurück zum Zitat Korovessis P, Petsinis G, Koureas G, Iliopoulos P, Zacharatos S (2006) Anterior surgery with insertion of titanium mesh cage and posterior instrumented fusion performed sequentially on the same day under one anesthesia for septic spondylitis of thoracolumbar spine: is the use of titanium mesh cages safe? Spine (Phila Pa 1976) 31:1014–1019CrossRef Korovessis P, Petsinis G, Koureas G, Iliopoulos P, Zacharatos S (2006) Anterior surgery with insertion of titanium mesh cage and posterior instrumented fusion performed sequentially on the same day under one anesthesia for septic spondylitis of thoracolumbar spine: is the use of titanium mesh cages safe? Spine (Phila Pa 1976) 31:1014–1019CrossRef
Metadaten
Titel
One-stage lumbopelvic fixation in the treatment of lumbosacral junction tuberculosis
verfasst von
Zhengquan Xu
Xiyang Wang
Xiongjie Shen
Chengke Luo
Ping Wu
Hao Zeng
Publikationsdatum
01.08.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
European Spine Journal / Ausgabe 8/2015
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-015-3863-8

Weitere Artikel der Ausgabe 8/2015

European Spine Journal 8/2015 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Aquatherapie bei Fibromyalgie wirksamer als Trockenübungen

03.05.2024 Fibromyalgiesyndrom Nachrichten

Bewegungs-, Dehnungs- und Entspannungsübungen im Wasser lindern die Beschwerden von Patientinnen mit Fibromyalgie besser als das Üben auf trockenem Land. Das geht aus einer spanisch-brasilianischen Vergleichsstudie hervor.

Endlich: Zi zeigt, mit welchen PVS Praxen zufrieden sind

IT für Ärzte Nachrichten

Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärzte und Psychotherapeuten.

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders scheint das auf weibliche Kranke zuzutreffen, wie eine Studie zeigt.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.