Clinical and radiological outcome analysis among patients with spondylitis tuberculosis of the lumbar vertebrae after correction and posterior instrumentation in cipto mangunkusumo and Fatmawati Hospital in 2018-2020: A cross sectional study.

Introduction: Spondylitis tuberculosis can cause changes in spinopelvic parameters including pelvic incidence, pelvic tilt, and sacral slope due to biomechanical changes of the spine. Posterior instrumentation is one of the modality for the treatment of spondylitis tuberculosis. However, in Indonesia, clinical and radiological outcomes after posterior instrumentation in tuberculosis of lumbar vertebrae are still rare. This study aims to investigate the clinical and radiological outcomes of patients with spondylitis tuberculosis of the lumbar vertebrae after posterior instrumentation.

Method: This study was a cross-sectional study in patients with spondylitis tuberculosis of the lumbar vertebrae who underwent posterior instrumentation in Cipto Mangunsukumo and Fatmawati Hospital. Subjects were collected through consecutive sampling. 23 subjects were collected and analyzed. Clinical and radiological outcomes before and after posterior instrumentation were compared. The clinical outcome included the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). The radiological outcome included sacral slope, pelvic tilt, pelvic incidence, and lumbar lordosis.

Results: The median age of the subjects was 31 (9-57) years with a female-majority (60,9%). The median of the total vertebral infected was 2 (1-4). Median of VAS score before surgery, 6 months after surgery, and 12 months after surgery were 9 (4-10), 4 (1-7), dan 2 (1-6) (p < 0,001) consecutively. Median of ODI score before surgery, 6 months after surgery, and 12 months after surgery were 70 (40-86), 34 (10-74), dan 12 (2-74) (p < 0,001) consecutively. There was no significant difference in spinopelvic parameters before and after the surgery. The difference of ODI score before and after the surgery inversely correlated with the difference of lumbar lordotic and sacral slope.

Conclusion: Posterior instrumentation could improve clinical outcomes in patients with spondylitis tuberculosis of the lumbar. Change of lumbar lordotic and sacral slope after posterior instrumentation led to an improvement of quality of life marked by the reduction of the ODI score.