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A novel indication for a method in the treatment of lumbar tuberculosis through minimally invasive extreme lateral interbody fusion (XLIF) in combination with percutaneous pedicle screws fixation in an elderly patient

View Article: PubMed Central - PubMed

ABSTRACT

Rationale:: To describe a novel indication for a method through minimally invasive extreme lateral interbody fusion (XLIF) in combination with percutaneous pedicle screwsfixation in the treatment of lumbar tuberculosis (TB) in an elderly patient, and its clinical efficacy and feasibility. Lumbar TB is a destructive form of TB. Antituberculous treatment should be started as early as possible. In some circumstances, however, surgical debridement with or without stabilization of the spine appears to be beneficial and may be recommended. Surgeries through the approach of anterior or posterior are still challenging and often involve some complications.

Patient concerns:: The case is a 68-year-old female who was misdiagnosed as simple vertebral compression fracture and underwent L1 and L2 percutaneous vertebroplasty in another hospital 7 years ago. He complained of lumbosacral pain for 1 month this time. Magnetic resonance imaging (MRI) and computed tomography (CT) showed intervertebral space in L1/2 was seriously damaged like TB.

Diagnoses:: Lumbar tuberculosis

Interventions:: Antitubercular drugs, mini-invasive debridement with XLIF in combination with percutaneous pedicle screwsfixation was performed. This patient was followed up for 12 months.

Outcomes:: No obvious complication occurred during the operation and the wound healed well. Oswestry Disability Index (ODI: 56 vs 22) and visual analog scale (VAS: 4 vs 0) score significantly decreased atfinal follow-up of 12 months. Obvious recovery of kyphosis angle was found postoperatively (post: 14.8° vs pre: 33.5°). No recurrent infection occurred at the last follow-up.

Lessons:: Mini-invasive surgery by debridement through XLIF and percutaneous pedicle screwsfixation may be an effective and innovative treatment method for lumbar TB in the elderly.

No MeSH data available.


Establishment of surgical channel through the lateral approach. Using primary dilator to separate the psoas (A1 and A2); guiding pin was placed to the lateral of interverbral disc through primary dilator under X-ray fluoroscopy (B); using expansion tube of different diameters (C1 and C2); the final dilator (surgical channel) was hooked up to the free arm and fixed beside the operating bed (D1–D3).
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Figure 2: Establishment of surgical channel through the lateral approach. Using primary dilator to separate the psoas (A1 and A2); guiding pin was placed to the lateral of interverbral disc through primary dilator under X-ray fluoroscopy (B); using expansion tube of different diameters (C1 and C2); the final dilator (surgical channel) was hooked up to the free arm and fixed beside the operating bed (D1–D3).

Mentions: When the lateral approach and dilator was established, intraoperative wake-up test was used in order to avoid the nerve root injury. Firstly the skin incision (about 2–3 cm in length) was paralleled to the vertical K-wires as mentioned before and aimed to the middle of upper and lower end plate. Then we used primary dilator to separate the psoas (Fig. 2A1 and A2) and guiding pin was placed to the lateral of interverbral disc through primary dilator under X-ray fluoroscopy (Fig. 2B). Then we continued to use expansion tube of different diameters (Fig. 2C1 and C2), the final dilator (surgical channel) was hooked up to the free arm and fixed beside the operating bed (Fig. 2D1–D3). Meanwhile, a light source was installed to the dilator (white arrow in Fig. 2D3).


A novel indication for a method in the treatment of lumbar tuberculosis through minimally invasive extreme lateral interbody fusion (XLIF) in combination with percutaneous pedicle screws fixation in an elderly patient
Establishment of surgical channel through the lateral approach. Using primary dilator to separate the psoas (A1 and A2); guiding pin was placed to the lateral of interverbral disc through primary dilator under X-ray fluoroscopy (B); using expansion tube of different diameters (C1 and C2); the final dilator (surgical channel) was hooked up to the free arm and fixed beside the operating bed (D1–D3).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5134771&req=5

Figure 2: Establishment of surgical channel through the lateral approach. Using primary dilator to separate the psoas (A1 and A2); guiding pin was placed to the lateral of interverbral disc through primary dilator under X-ray fluoroscopy (B); using expansion tube of different diameters (C1 and C2); the final dilator (surgical channel) was hooked up to the free arm and fixed beside the operating bed (D1–D3).
Mentions: When the lateral approach and dilator was established, intraoperative wake-up test was used in order to avoid the nerve root injury. Firstly the skin incision (about 2–3 cm in length) was paralleled to the vertical K-wires as mentioned before and aimed to the middle of upper and lower end plate. Then we used primary dilator to separate the psoas (Fig. 2A1 and A2) and guiding pin was placed to the lateral of interverbral disc through primary dilator under X-ray fluoroscopy (Fig. 2B). Then we continued to use expansion tube of different diameters (Fig. 2C1 and C2), the final dilator (surgical channel) was hooked up to the free arm and fixed beside the operating bed (Fig. 2D1–D3). Meanwhile, a light source was installed to the dilator (white arrow in Fig. 2D3).

View Article: PubMed Central - PubMed

ABSTRACT

Rationale:: To describe a novel indication for a method through minimally invasive extreme lateral interbody fusion (XLIF) in combination with percutaneous pedicle screwsfixation in the treatment of lumbar tuberculosis (TB) in an elderly patient, and its clinical efficacy and feasibility. Lumbar TB is a destructive form of TB. Antituberculous treatment should be started as early as possible. In some circumstances, however, surgical debridement with or without stabilization of the spine appears to be beneficial and may be recommended. Surgeries through the approach of anterior or posterior are still challenging and often involve some complications.

Patient concerns:: The case is a 68-year-old female who was misdiagnosed as simple vertebral compression fracture and underwent L1 and L2 percutaneous vertebroplasty in another hospital 7 years ago. He complained of lumbosacral pain for 1 month this time. Magnetic resonance imaging (MRI) and computed tomography (CT) showed intervertebral space in L1/2 was seriously damaged like TB.

Diagnoses:: Lumbar tuberculosis

Interventions:: Antitubercular drugs, mini-invasive debridement with XLIF in combination with percutaneous pedicle screwsfixation was performed. This patient was followed up for 12 months.

Outcomes:: No obvious complication occurred during the operation and the wound healed well. Oswestry Disability Index (ODI: 56 vs 22) and visual analog scale (VAS: 4 vs 0) score significantly decreased atfinal follow-up of 12 months. Obvious recovery of kyphosis angle was found postoperatively (post: 14.8° vs pre: 33.5°). No recurrent infection occurred at the last follow-up.

Lessons:: Mini-invasive surgery by debridement through XLIF and percutaneous pedicle screwsfixation may be an effective and innovative treatment method for lumbar TB in the elderly.

No MeSH data available.