Posterior instrumentation using compressive laminar hooks and anterior interbody arthrodesis for the treatment of tuberculosis of the lower lumbar spine

Abstract

Study Design. A retrospective review with clinical and radiologic assessment was conducted. Objective. To demonstrate the feasibility of posterior short segment augmentation with lamina hook and anterior lumbar interbody arthrodesis in tuberculosis of the lumbar spine by evaluating clinical results, fusion status, and sagittal angle. Summary of Background Data. There are few articles in the literature describing circumferential treatment of lumbar tuberculosis. We have had significant experience with a uniform operative technique for the treatment of this relatively rare condition and report our results with a minimum 2-year follow-up. Methods. Twenty-three patients with tuberculosis of the lower lumbar spine underwent posterior instrumentation with laminar hooks and anterior interbody arthrodesis by a single surgeon. The clinical outcomes were evaluated with preoperative and postoperative questionnaires, and the radiographs were independently analyzed with respect to fusion status and sagittal angle. Results. The mean follow-up period was 28.7 months ( range, 24 - 39 months). The average preoperative, immediate postoperative, and final follow-up sagittal angles were 2.7degrees, - 14.1degrees, and -11.5degrees, respectively. There was a mean reduction of 16.7degrees ( range, 9degrees- 23degrees) after surgery. Two patients had a correction loss more than 5degrees during the follow-up period. Bony fusion was obtained in all patients. There was no recurrence of the disease. Conclusion. This technique appears to be effective in stabilizing the vertebrae, restoring lordosis, achieving a solid fusion, and improving clinical outcome without sacrificing additional motion segments.