Treatment of single-segment lumbar tuberculosis by unilateral biportal endoscopic debridement, interbody fusion, and percutaneous pedicle screw fixation

Introduction : Unilateral biportal endoscopic (UBE) technique is an emerging minimally invasive spinal surgical technique that has been used to treat a variety of degenerative spinal diseases in recent years, while there are rare reports on the treatment of lumbar tuberculosis (LTB). Consequently, this study intends to investigate the effectiveness and feasibility of UBE debridement, interbody fusion, and percutaneous pedicle screw fixation for single-segment LTB. Methods : A total of 31 patients with single-segment LTB from January 2020 to September 2021 were included. The operative time, estimated blood loss, time to ambulation, postoperative hospital stay, and complications were recorded. Clinical outcomes include erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), the visual analog scale (VAS) score, Oswestry disability index (ODI), American Spinal Injury Association (ASIA) neurological classification, Cobb angle, and lumbar lordotic angle were analyzed. X-rays or computerized tomography (CT) were reviewed 6 months after surgery and at the final follow-up, and surgical segmental fusion was evaluated using Bridwell grading criteria. Results : The mean operative time was 171.61 ± 19.03 minutes, the mean estimated blood loss was 243.87 ± 26.54 ml, the mean time to ambulation was 1.87 ± 0.76 days postoperatively, and the mean postoperative hospital stay was 5.61 ± 1.17 days. There were 4 cases of procedure-related complications and the incidence was 12.9%. The levels of ESR and CRP returned to normal 3 months after the procedure. VAS scores of low back and leg, as well as ODI, were significantly improved postoperatively compared with before the operation, and the differences were statistically significant ( P  < 0.05). All patients were ASIA grade E at the last follow-up. The postoperative Cobb angle was 9.81 ± 2.4 ^° , the lumbar lordotic angle was 42.59 ± 6.16 ^° , and both had no significant loss of correction during the final follow-up. Bony fusion was achieved in all cases at the final follow-up. Conclusions : UBE debridement, interbody fusion, and percutaneous pedicle screw fixation is a feasible, effective, and safe surgical procedure for the treatment of single-segment LTB.