One-Stage Anterior Approach with Arch Plate to Treat Lumbosacral Tuberculosis

This article describes the arch plate technique for treating lumbosacral tuberculosis. Lumbosacral tuberculosis often leads to the destruction of anterior vertebral columns and presacral or iliopsoas abscess, which requires an anterior approach to achieve thorough debridement. Due to the complexity of the anatomical structure of lumbosacral spine and the high requirement of fixation stability, a combined posterior approach to perform internal fixation is necessary, which is rather traumatic. On the other hand, most of the current anterior lumbosacral internal fixation systems cannot be applied to spinal tuberculosis patients who have irregular bony endplate destruction. The arch plate was designed as a cephalic narrow and caudal wide trapezoid or triangle outline according to the preliminary anatomic research. In terms of the endplate bony destruction, a multidirectional technique was introduced in the arch screws, which enables surgeons to arbitrarily change the direction of the screw in the range of 5°-20°, which increases the length and the inclination angles in the sagittal plane of the implant screw and makes sure that the autologous iliac bone graft fits the irregular bone destruction for maximum stability. This study demonstrated the effectiveness of one-stage anterior debridement, bone grafting, and arch plate fixation to treat lumbosacral tuberculosis. The risk of intraoperative and postoperative complications, such as injury to major vessels, could be minimized. This surgical procedure had many advantages, including a shorter operation time, less blood loss, and better functional recovery over the conventional combined anterior and posterior approach.