Treatment of lumbar and lumbosacral spinal tuberculosis with minimally invasive surgery

Objective: To evaluate the outcome of computed tomography (CT)‐guided percutaneous puncture and local chemotherapy for tuberculosis (TB) of the lumbar or lumbosacral spine. Methods: From January 2002 to August 2006, 49 patients with lumbar or lumbosacral spinal TB in whom conservative treatment had failed were treated by minimally invasive surgery. There were 21 female and 28 male patients. The mean age of the patients was 47 ± 18 years (range from 12 to 78 years). There were 40 cases with lumbar TB, and 9 with lumbosacral TB. From L₁ to S₁, the involved vertebral numbers were 8, 26, 19, 19, 21 and 10, respectively. In 3 patients the spinal TB involved a single vertebra, in 39 patients two, in 6 patients three and in only one case four vertebrae. According to the Frankel scale, three patients had grade E incomplete paralysis preoperatively. The outcome, after treatment by CT‐guided percutaneous puncture and local chemotherapy, was retrospectively analyzed according to the preoperative and postoperative kyphotic angles and the Oswestry disability index (ODI). Results: Forty‐nine patients were followed up for from one year to 5 years and 8 months (average 35 months). All cases recovered, and there was no recurrence. Preoperatively, the kyphotic angle was 16.47°± 8.74°, and it had decreased to 13.35°± 8.02° by the final follow‐up (t= 5.79, P < 0.001). The average ODI score had improved from 70.12 ± 22.24 to 12.72 ± 8.62 (t= 21.42, P < 0.001). Conclusion: The majority of cases of lumbar and lumbosacral spinal TB can achieve satisfactory results with minimally invasive surgery. Its clinical application is therefore strongly recommended.