Comparison Between the Efficacy of Oblique Lumbar Debridement Using an Expandable Channel Combined With Posterior Percutaneous Internal Fixation and Traditional Anterior-Posterior Surgery for Single-Segment Lumbar Tuberculosis.

Abstract

Aim: Lumbar tuberculosis can cause spinal instability and neurological deficits, often requiring surgery. Traditional anterior-posterior surgery is effective but highly invasive, leading to greater trauma and longer recovery. Minimally invasive techniques, such as oblique lumbar debridement with posterior percutaneous fixation, may reduce surgical damage and improve recovery. However, their efficacy remains unclear. This study compares this minimally invasive approach with conventional surgery to assess its feasibility as an alternative treatment.

Methods: A retrospective analysis was conducted on 156 patients diagnosed with single-segment lumbar tuberculosis between July 2016 and October 2019. Patients were divided into a minimally invasive group (Min group, n = 76), treated with the oblique lumbar approach combined with Posterior Percutaneous Pedicle Screw Fixation (PPPSF), and a conventional Open group (n = 80). All patients received standard anti-tuberculosis therapy (isoniazid, rifampicin, pyrazinamide, and ethambutol) for at least two weeks preoperatively and continued for 10-12 months postoperatively, adjusted based on drug sensitivity testing. Nutritional support and bracing for three months post-surgery were also provided. Surgical and postoperative metrics were evaluated, including operative time, intraoperative blood loss, length of abdominal incision, postoperative drainage volume and postoperative hospital stay. Functional outcomes were assessed using the visual analogue scale (VAS) and oswestry disability index (ODI), while serology markers such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and creatine phosphokinase (CPK) levels were measured. Radiographic parameters, including the Cobb angle and sagittal vertical axis (SVA), were also evaluated. Postoperative complications were also documented.

Results: The Min group demonstrated significantly shorter operation time, smaller incisions, reduced blood loss, shorter hospital stays, and lower postoperative drainage and CPK levels compared to the conventional Open group (p < 0.05). There was no significant difference in VAS, ODI, ESR and CRP levels between the two groups at different times after surgery (p > 0.05). Radiographic assessments revealed no significant differences in the Cobb angle or SVA at any postoperative time point (p > 0.05). However, the Min group exhibited a significantly higher rate of Grade 1 spinal fusion (59 vs. 38 cases, p < 0.05). Although postoperative complications were lower in the Min group (14.5% vs. 18.8%), the difference was not statistically significant (p = 0.474).

Conclusions: Oblique lumbar debridement with PPPSF represents a viable alternative to traditional anterior-posterior surgery for single-segment lumbar tuberculosis, offering reduced surgical trauma and accelerated postoperative recovery.