Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2025; 16(7): 106041
Published online Jul 18, 2025. doi: 10.5312/wjo.v16.i7.106041
Treatment of lumbar tuberculosis with minimally invasive anterior lesion clearance combined with posterior fixation
Fei-Fei Pu, Xiang-Lin Peng, Fang-Zheng Zhou, Xiao-Long Zhao, Ling Yang, Jun-Qing Cao, Liu Wei, Jing Feng, Ping Xia
Fei-Fei Pu, Xiang-Lin Peng, Fang-Zheng Zhou, Xiao-Long Zhao, Ling Yang, Jun-Qing Cao, Liu Wei, Jing Feng, Department of Orthopedics, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Fei-Fei Pu, Xiang-Lin Peng, Fang-Zheng Zhou, Xiao-Long Zhao, Ling Yang, Jun-Qing Cao, Liu Wei, Jing Feng, Department of Orthopedics, Wuhan No. 1 Hospital, Wuhan 430022, Hubei Province, China
Ping Xia, Department of Orthopedics, Wuhan Fourth Hospital (Puai Hospital), Wuhan 430022, Hubei Province, China
Co-first authors: Fei-Fei Pu and Xiang-Lin Peng.
Co-corresponding authors: Jing Feng and Ping Xia.
Author contributions: Pu FF and Peng XL retrieved and analyzed patient data and imaging; Zhou FZ, Zhao XL, and Yang L conducted the literature review and drafted the original manuscript; Cao JQ and Liu W reviewed and revised the manuscript; Xia P and Feng J made substantial contributions to data retrieval and interpretation. All authors read and approved the final manuscript. Pu FF and Peng XL contributed equally to this work as co-first authors. This research project was initiated and partially completed by Xia P, who also secured the initial funding. Following Xia P's career transition, Feng J assumed responsibility for the remaining work. Both investigators made substantial contributions to the project's design, oversight, and financial support. Their collaborative design efforts established the study's conceptual framework and research trajectory, while their joint supervision guaranteed methodological rigor and academic integrity. The equal financial contributions from both researchers were instrumental in facilitating the project's implementation. The smooth transition of responsibilities between the two principal investigators demonstrates their effective professional collaboration.
Supported by Medical Research Project of Wuhan Municipal Health Commission, No. WX21M02.
Institutional review board statement: This study was approved by the Ethics Committee of Wuhan Hospital of Traditional Chinese and Western Medicine (Wuhan No.1 Hospital), Tongji Medical College, Huazhong University of Science and Technology and strictly adhered to the tenets of the Declaration of Helsinki. In addition, the parents or guardians of the study participants gave written consent to participate in the study, and the informed consent was obtained from all subjects and/or their legal guardian(s).
Informed consent statement: Written informed consent was obtained from the patients’ guardians for publication of clinical data.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: The datasets of the current study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ping Xia, MD, PhD, Chief Physician, Director, Department of Orthopedics, Wuhan Fourth Hospital (Puai Hospital), No. 473 Hanzheng Road, Wuhan 430022, Hubei Province, China. xiapingfm@163.com
Received: February 17, 2025
Revised: April 13, 2025
Accepted: June 13, 2025
Published online: July 18, 2025
Processing time: 152 Days and 18.4 Hours
Abstract
BACKGROUND

Spinal tuberculosis, a destructive extrapulmonary form, often causes severe deformity and neurological deficits. Surgical intervention aims to debride lesions, reconstruct stability, and correct deformities. This study evaluates a combined posterior fixation and minimally invasive anterior approach for lumbar tuberculosis.

AIM

To evaluate the clinical outcomes and radiological parameters of posterior internal fixation combined with minimally invasive anterior lesion clearance and bone graft fusion for the treatment of lumbar tuberculosis.

METHODS

Clinical data from 24 patients with lumbar tuberculosis who underwent posterior pedicle screw fixation combined with minimally invasive anterior lesion clearance were analyzed. The Cobb angle, visual analog scale (VAS) score, and Frankel classification were statistically assessed preoperatively and postoperatively. Complications and bone graft fusion were also recorded.

RESULTS

Wounds healed in the first stage in 22 patients; one patient developed a posterior incisional sinus tract, and one experienced postoperative tuberculosis recurrence. At the final follow-up, according to the Frankel classification, there were 1, 2, and 21 cases classified as grade C, grade D, and grade E, respectively. By the last follow-up, the Cobb angle, VAS score, and erythrocyte sedimentation rate had all decreased. Both X-ray and computed tomography images confirmed bone healing. The fusion time ranged from 3 to 9 months, with an average of 5.2 months.

CONCLUSION

Posterior pedicle screw fixation combined with minimally invasive anterior lesion clearance is an effective and safe treatment for lumbar tuberculosis.

Keywords: Lumbar tuberculosis; Pedicle screw fixation; Minimally surgery; Lesion removal

Core Tip: This study demonstrates that posterior pedicle screw fixation combined with minimally invasive anterior lesion clearance and bone graft fusion is an effective and safe treatment for lumbar tuberculosis. Clinical outcomes showed significant improvements in Cobb angle, pain relief (visual analog scale score), and neurological function (Frankel classification), with a high rate of first-stage wound healing (22/24 cases) and successful bone fusion (average: 5.2 months). While complications were rare (one case of incisional sinus tract and one recurrence), the combined approach offers minimally invasive advantages, including reduced soft tissue damage, faster recovery, and stable spinal reconstruction. These findings support its use as a viable surgical strategy for lumbar tuberculosis, balancing radical debridement, deformity correction, and functional restoration while minimizing morbidity. Further studies with larger cohorts are warranted to validate long-term efficacy.