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

来源 :第三届全国脊柱结核诊疗新技术研讨会暨2017年湖南省医学会脊柱外科专业委员会年会 | 被引量 : 0次 | 上传用户:livan_s
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  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 fre-quently 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 lim-ited,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-oid male patient with thoracic tuberculosis who underwent surgical treatment by debride-ment,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.Pro-tect 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 com-press both sides to make the mesh cages and bone blocks tight.Reconstruct posterior column structure with alloge-neic 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.
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