Treatment of Spinal Tuberculosis by Debridement, Interbody Fusion and Internal Fixation via Posterior Approach Only

Abstract

Surgical treatment for spinal tuberculosis includes focal tuberculosis debridement, segmental stability reconstruction, neural decompression and kyphotic deformity correction. For the lesions mainly involved anterior and middle column of the spine, anterior operation of debridement and fusion with internal fixation has been becoming the most frequently used surgical technique for the spinal tuberculosis. However, high risk of structural damage might relate with anterior surgery, such as damage in lungs, heart, kidney, ureter and bowel, and the deformity correction is also limited. Due to the organs are in the front of spine, there are less complications in posterior approach. Spinal pedicle screw passes through the spinal three‐column structure, which provides more powerful orthopedic forces compared with the vertebral body screw, and the kyphotic deformity correction effect is better in posterior approach. In this paper, we report a 68‐year‐old male patient with thoracic tuberculosis who underwent surgical treatment by debridement, interbody fusion and internal fixation via posterior approach only. The patient was placed in prone position under general anesthesia. Posterior midline incision was performed, and the posterior spinal construction was exposed. Then place pedicle screw, and fix one side rod temporarily. Make the side of more bone destruction and larger abscess as lesion debridement side. Resect the unilateral facet joint, and retain contralateral structure integrity. Protect the spinal cord, nerve root. Clear sequestrum, necrotic tissue, abscess of paravertebral and intervertebral space. Specially designed titanium mesh cages or bone blocks were implanted into interbody. Fix both side rods and compress both sides to make the mesh cages and bone blocks tight. Reconstruct posterior column structure with allogeneic bone and autologous bone. Using this technique, the procedures of debridement, spinal cord decompression, deformity correction, bone grafting, and internal fixation can be completed with only one incision and surgical position, and the deformity correction efficiency is higher than anterior surgery.

Minimally invasive direct lateral interbody fusion in the treatment of the thoracic and lumbar spinal tuberculosisMini-DLIF for the thoracic and lumbar spinal tuberculosis

“…The complications of Spinal tuberculosis including instability of the spine, spinal deformity and spinal cord compression, and even paralysis. Surgical therapy is recommended and required after the above complications occur [2]. However, traditional surgical treatment has the features of large trauma and slow postoperative recovery.…”

Digital Anatomical Measurement for Anterolateral Fixation of Middle and Lower Thoracic Vertebrae

“…A too-short screw cannot sufficiently prop the compressed segments [12], and it is easy to damage the surrounding blood vessels, nerves, and other tissues during spinal flexion and extension with a too-long screw [13]. According to the measurement data of vertebral heights, most segments in the middle and lower thoracic vertebrae took the shape of an elliptical cylinder that was slightly higher at the edges and slightly lower in the middle (for some segments, the anterior edge was at a similar height as the posterior edge or the middle part).…”

A comparative study of oblique lumbar interbody fusion combined posterior percutaneous internal fixation and the anterior-posterior combined surgery in the treatment of single-segment lumbar tuberculosis

“…Among systemic bone and joint tuberculosis,the incidence of spinal tuberculosis is the highest,about 50%,of which lumbar tuberculosis accounts for 22.8%-45% [1,2].Most patients can be cured with systemic nutritional support and reasonable anti-tuberculosis treatment [3].However,in spite of adequate medical treatment,some patients'condition is still progressing,forming cold abscess,spinal instability,symptoms of spinal cord or cauda equina compression,kyphosis,etc.Surgical therapy is indicated and recommended after the above complications occur [4]. xation.At present,the combination of two minimally invasive techniques has not been reported in the literature for the minimally invasive treatment of lumbar tuberculosis.Therefore,we will combine two minimally invasive procedures for the treatment of single-segment lumbar tuberculosis,and compare them with the classical combined anterior and posterior surgery to evaluate the clinical effect,which is reported as follows:…”