Mid- to Long-Term Follow-up Outcomes of One-Stage Posterior Lumbosacral or Lumbopelvic Fixation in the Management of Lumbosacral Junction Tuberculosis in Adults

Abstract

Background: This retrospective study aimed to evaluate the mid- to long-term outcomes of surgical management of lumbosacral junction tuberculosis in adults. Methods: A total of 38 adult patients were treated by one-stage posterior debridement, interbody fusion, lumbosacral or lumbopelvic fixation, and postural drainage. All cases were followed up for at least five years. Clinical and radiographic outcomes were gathered and analyzed.Results: All patients achieved clinical cure at the last follow-up. Erythrocyte sedimentation rates decreased to normal levels within three months postoperatively. Postoperative scores measuring pain (visual analog scale), neurological status (Japanese Orthopedic Association score), and patient quality of life (Oswestry Disability Index) all significantly improved compared to preoperative values. Patient-reported outcomes as measured by Kirkaldy-Willis criteria were excellent in 21 cases, good in 16 cases, and fair in 1 case; there were no poor outcomes. Lumbosacral angle increased from the preoperative values of 21.7° ± 1.8° to the postoperative values of 26.4° ± 1.4°, with an angle loss of 1.2° ± 0.7° at the last follow-up. Bone fusion occurred on average 12.8 ± 1.9 months after surgery. No nonunion, pseudarthrosis, loosening or fracture of instruments occurred at the last follow-up.Conclusion: For patients with lumbosacral junction TB, a treatment protocol including one-stage posterior debridement, interbody fusion, lumbosacral or lumbopelvic fixation, and postural drainage according to the severity of sacral destruction is a relatively nontraumatic and highly safe procedure. It can be used to reconstruct lumbosacral or lumbopelvic stability and facilitate the healing of TB.