Surgical treatment for lumbar tuberculosis by posterior transforaminal lumbar debridement, interbody fusion, and instrumentation in the aged

Object: To evaluate the clinical efficacy and feasibility of single-stage posterior debridement, interbody fusion and posterior instrumentation for the treatment of lumbar tuberculosis in the aged and to discuss the surgical strategies of this intervention. Methods: From January 2006 to January 2012, 28 elderly patients who suffered from lumbar tuberculosis underwent one-stage posterior debridement, interbody fusion and posterior instrumentation. Radiographic data which included correction of local kyphosis, loss of correction and bone fusion were carefully collected pre and postoperatively to evaluate the efficacy of surgery. Perioperative and postoperative complications were also registered. All patients were asked to fill out Oswestry Disability Index questionnaire before the surgery and at the last follow-up. Results: All patients (12M/16F) were followed for at least 24 months. The average kyphotic angle decreased to 11.3 degrees +/- 7.0 degrees postoperatively from 26.4 degrees +/- 5.7 degrees preoperatively. Meanwhile, average loss of 2.0 degrees +/- 1.5 degrees was observed at last visit. Bone fusion occurred at 4-6 months. Neither mortalities nor any neurological complications were found in the series. 16 cases who suffered neurologic insults before surgery, the majority of patients recovered after surgery. The mean Oswestry Disability Index was significantly improved from 28.6 +/- 4.9 before surgery to 10.4 +/- 3.8 at last visit. Conclusions: The outcomes of follow-up showed that single-stage posterior debridement, interbody fusion and instrumentation is an effective method for the treatment of lumbar tuberculosis in the aged.