Radical Operation in Tuberculosis of the Spine

Abstract

Pre-and post-operative orthopaedic treatment Chemotherapy 19 Chapter 4. Studies on the concentration of streptomycin Chapter 5. Pathology and pathogenesis Chapter ti. Bacteriologic examinations 38 Culture of the tubercle bacillus and guinea pig inoculation Resistance to streptomycin Routine culture Chapter 7. Exploratory operations Chapter 8. Therapeutic results Survey of the literature Results in the present series Follow-up investigation Clinical results and definitions Radiographic results and definitions 55 Influence of different factors on the results Complications 66 Recurrence 67 Length of treatment Interval between operation and resumption of work 68 Deaths 69 Chapter 9. Case Reports 71 Chapter 10. Discussion and conclusions 89 Summary 98 Rdsume 102 Zusammenfassung 107 Acknowledgements HI References 112 produced from os purum (bone freed from connective tissue, protein and fat) which for some time has been implanted subperiosteally on the tibia. Direct operations into the tuberculous spine lesion were reported as early as in the 1880's. MENARD'S monograph (1900) contained detailed accounts of these early radical operations at which large incisions were made into the abscesses, the abscess capsules were excised and tuberculous granulation tissue was scraped out. CHIPAULT compiled the results of these operations by various workers. MENARD, however, considered that the therapeutic results were so poor that he preferred a method of his own by which he punctured the abscesses and injected some caustic agent. He tried the operative treatment himself but found that it was justified only when the injection therapy failed or when the abscesses threatened to perforate. The operations mentioned here were performed in uncomplicated cases of spon dylitis with closed lesions. In cases complicated by paraplegia decompression laminectomy was performed by MAYER as early as 1846 (the patient died 21 days after opera tion), and by OLLIER, 1882 (the patient survived and the paraplegia sub sided). The subsequent results of laminectomy were discouraging, and MENARD asserted that by laminectomy the posterior intact support, the arch, is removed while the anterior one, the vertebral body, is already destroyed. His .studies of autopsy cases showed that the compression occurs in front of the spinal cord and that in many cases the posterior arch has no contact at all with the compressed spinal cord. SCHMIEDEN advised against operation by summarizing: "Es darf heute als ein Wagnis bezeichnet werden, noch viel von operativer Therapie der Spondylitis zu sprechen, nachdem BERNARD und ROLLIER glanzende Erfolge mit der geduldigen konservativen khmatischen Behandlung der chirurgischen Tuberkulose erzielt haben." SCHMIEDEN also advised against lamin ectomy in paraplegia for the same reasons as MENARD. The record com prised 251 patients subjected to laminectomy, of whom 74 died. In 1934 the Japanese worker fro et al. reported 10 cases of radical opera tion, in thoracic spine involvement using costotransversectomy, in lumbar involvement extr...

Surgical Management of Spinal Tuberculosis—The Past, Present, and Future

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