PDF herunterladen
CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(02): 327-332
DOI: 10.1055/s-0042-1748788
Case Report

Bilateral Percutaneous Transpedicular Drainage under Local Anesthesia for Thoracic Tuberculous Spondylitis

Yoshinori Maki
1   Department of Neurosurgery, Hikone Chuo Hospital, Shiga, Japan
2   Department of Rehabilitation, Hikari Hospital, Shiga, Japan
,
Motohiro Takayama
3   Department of Neurosurgery, Otsu City Hospital, Shiga, Japan
,
Kohichi Go
3   Department of Neurosurgery, Otsu City Hospital, Shiga, Japan
› Institutsangaben
› Weitere Informationen
   Lizenzen und Reprints

Abstract

Tuberculous spondylitis is a common spinal infection. If surgical intervention is necessary, anterior debridement and anterior fixation are typically performed. However, a minimally invasive surgical strategy under local anesthesia seems rarely implemented.

A 68-year-old man presented with severe pain in the left flank. Whole spinal magnetic resonance imaging revealed abnormal intensity of vertebral bodies from T6–9. A bilateral paravertebral abscess extending from T4–10 was suspected. The T7/T8 intervertebral disc was destroyed, but severe vertebral deformity or spinal cord compression was not observed. Bilateral percutaneous transpedicular drainage under local anesthesia was planned. The patient was set in the prone position. Under the guide of a biplanar angiographic system, the bilateral drainage tubes were placed paravertebrally in the abscess cavity. The left flank pain improved after the procedure. Laboratory culture of the pus specimen confirmed a diagnosis of tuberculosis. A chemotherapy regimen for tuberculosis was soon initiated. The patient was discharged during postoperative week 2, with continuation of chemotherapy for tuberculosis.

Percutaneous transpedicular drainage under local anesthesia can be effective in the management of thoracic tuberculous spondylitis without severe vertebral deformity or compression of the spinal cord by an abscess.

Keywords

tuberculosis spondylitis - minimum invasive surgery - transpedicular drainage - thoracic spine

Authors' Contributions

Y.M. contributed in drafting the article. M.T. contributed in revising the article critically and final approval of the manuscript to be submitted. K.G. contributed in the conception and design of the study and acquisition of data.




Publikationsverlauf

Artikel online veröffentlicht:
16. Juni 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Zhang N, Zeng X, He L. et al. The value of MR imaging in comparative analysis of spinal infection in adults: pyogenic versus tuberculous. World Neurosurg 2019; 128: e806-e813
    CrossrefPubMedGoogle Scholar
  • 2 Lee KY. Comparison of pyogenic spondylitis and tuberculous spondylitis. Asian Spine J 2014; 8 (02) 216-223
    CrossrefPubMedGoogle Scholar
  • 3 Tsiodras S, Falagas ME. Clinical assessment and medical treatment of spine infections. Clin Orthop Relat Res 2006; 444 (444) 38-50
    CrossrefPubMedGoogle Scholar
  • 4 Wu W, Li Z, Wang S, Zhang H, Lin R, Lin J. One-stage surgical treatment for consecutive multisegment thoracic spinal tuberculosis with kyphosis by posterior-only debridement, interbody fusion, and instrumentation. World Neurosurg 2019; 128: e238-e244
    CrossrefPubMedGoogle Scholar
  • 5 Turgut M. Spinal tuberculosis (Pott's disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients. Neurosurg Rev 2001; 24 (01) 8-13
    CrossrefPubMedGoogle Scholar
  • 6 Ansari S, Amanullah MF, Ahmad K, Rauniyar RK. Pott's spine: diagnostic imaging modalities and technology advancements. N Am J Med Sci 2013; 5 (07) 404-411
    CrossrefPubMedGoogle Scholar
  • 7 An HS, Seldomridge JA. Spinal infections: diagnostic tests and imaging studies. Clin Orthop Relat Res 2006; 444 (444) 27-33
    CrossrefPubMedGoogle Scholar
  • 8 Zhang H, Zeng K, Yin X, Huang J, Tang M, Guo C. Debridement, internal fixation, and reconstruction using titanium mesh for the surgical treatment of thoracic and lumbar spinal tuberculosis via a posterior-only approach: a 4-year follow-up of 28 patients. J Orthop Surg Res 2015; 10: 150
    CrossrefPubMedGoogle Scholar
  • 9 Rajasekaran S. Kyphotic deformity in spinal tuberculosis and its management. Int Orthop 2012; 36 (02) 359-365
    CrossrefPubMedGoogle Scholar
  • 10 Yang H, Hou K, Zhang L. et al. Minimally invasive surgery through the interlaminar approach in the treatment of spinal tuberculosis: a retrospective study of 31 patients. J Clin Neurosci 2016; 32: 9-13
    CrossrefPubMedGoogle Scholar
  • 11 Jain AK, Kumar J. Tuberculosis of spine: neurological deficit. Eur Spine J 2013; 22 (Suppl. 04) 624-633
    CrossrefPubMedGoogle Scholar
  • 12 Kaloostian PE, Gokaslan ZL. Current management of spinal tuberculosis: a multimodal approach. World Neurosurg 2013; 80 (1,2): 64-65
    CrossrefPubMedGoogle Scholar
  • 13 Pellisé F. Tuberculosis and Pott's disease, still very relevant health problems. Eur Spine J 2013; 22 (Suppl. 04) 527-528
    CrossrefPubMedGoogle Scholar
  • 14 Tuli SM. Historical aspects of Pott's disease (spinal tuberculosis) management. Eur Spine J 2013; 22 (Suppl. 04) 529-538
    CrossrefPubMedGoogle Scholar
  • 15 Zhao C, Pu X, Zhou Q. et al. Can a posterior approach effectively heal thoracic and lumbar tuberculosis? Microbiology outcomes of the operative area. J Orthop Surg Res 2019; 14 (01) 24
    CrossrefPubMedGoogle Scholar
  • 16 Wang B, Lv G, Liu W, Cheng I. Anterior radical debridement and reconstruction using titanium mesh cage for the surgical treatment of thoracic and thoracolumbar spinal tuberculosis: minimium five-year follow-up. Turk Neurosurg 2011; 21 (04) 575-581
    PubMedGoogle Scholar
  • 17 Liu J, Wan L, Long X, Huang S, Dai M, Liu Z. Efficacy and safety of posterior versus combined posterior and anterior approach for the treatment of spinal tuberculosis: a meta-analysis. World Neurosurg 2015; 83 (06) 1157-1165
    CrossrefPubMedGoogle Scholar
  • 18 Güzey FK, Emel E, Bas NS. et al. Thoracic and lumbar tuberculous spondylitis treated by posterior debridement, graft placement, and instrumentation: a retrospective analysis in 19 cases. J Neurosurg Spine 2005; 3 (06) 450-458
    CrossrefPubMedGoogle Scholar
  • 19 Chen WJ, Wu CC, Jung CH, Chen LH, Niu CC, Lai PL. Combined anterior and posterior surgeries in the treatment of spinal tuberculous spondylitis. Clin Orthop Relat Res 2002; (398) 50-59
    CrossrefPubMedGoogle Scholar
  • 20 Zhang H, Sheng B, Tang M. et al. One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via posterior-only approach. Eur Spine J 2013; 22 (03) 616-623
    CrossrefPubMedGoogle Scholar
  • 21 Gan F, Jiang J, Xie Z. et al. Minimally invasive direct lateral interbody fusion in the treatment of the thoracic and lumbar spinal tuberculosisMini-DLIF for the thoracic and lumbar spinal tuberculosis. BMC Musculoskelet Disord 2018; 19 (01) 283
    CrossrefPubMedGoogle Scholar
  • 22 Lv GH, Wang B, Li J, Liu WD, Yin GH, Ma ZM. Thoracoscopy-assisted mini-open surgery for anterior column reconstruction in thoracic spinal tuberculosis. Orthop Surg 2009; 1 (04) 293-299
    CrossrefPubMedGoogle Scholar
  • 23 Garg N, Vohra R. Minimally invasive surgical approaches in the management of tuberculosis of the thoracic and lumbar spine. Clin Orthop Relat Res 2014; 472 (06) 1855-1867
    CrossrefPubMedGoogle Scholar
  • 24 Benli IT, Acaroğlu E, Akalin S, Kiş M, Duman E, Un A. Anterior radical debridement and anterior instrumentation in tuberculosis spondylitis. Eur Spine J 2003; 12 (02) 224-234
    CrossrefPubMedGoogle Scholar
  • 25 Huang YP, Lin JH, Chen XP, Wu G, Chen XW. Preliminary experience in treating thoracic spinal tuberculosis via a posterior modified transfacet debridement, instrumentation, and interbody fusion. J Orthop Surg Res 2018; 13 (01) 292
    CrossrefPubMedGoogle Scholar
  • 26 Li M, Du J, Meng H, Wang Z, Luo Z. One-stage surgical management for thoracic tuberculosis by anterior debridement, decompression and autogenous rib grafts, and instrumentation. Spine J 2011; 11 (08) 726-733
    CrossrefPubMedGoogle Scholar
  • 27 Zhang HQ, Lin MZ, Shen KY. et al. Surgical management for multilevel noncontiguous thoracic spinal tuberculosis by single-stage posterior transforaminal thoracic debridement, limited decompression, interbody fusion, and posterior instrumentation (modified TTIF). Arch Orthop Trauma Surg 2012; 132 (06) 751-757
    CrossrefPubMedGoogle Scholar
  • 28 Zhang HQ, Guo CF, Xiao XG, Long WR, Deng ZS, Chen J. One-stage surgical management for multilevel tuberculous spondylitis of the upper thoracic region by anterior decompression, strut autografting, posterior instrumentation, and fusion. J Spinal Disord Tech 2007; 20 (04) 263-267
    CrossrefPubMedGoogle Scholar
  • 29 Zhang HQ, Li JS, Zhao SS. et al. Surgical management for thoracic spinal tuberculosis in the elderly: posterior only versus combined posterior and anterior approaches. Arch Orthop Trauma Surg 2012; 132 (12) 1717-1723
    CrossrefPubMedGoogle Scholar
  • 30 Pu X, Zhou Q, He Q. et al. A posterior versus anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberculosis. Int Orthop 2012; 36 (02) 307-313
    CrossrefPubMedGoogle Scholar
  • 31 Lee SH, Sung JK, Park YM. Single-stage transpedicular decompression and posterior instrumentation in treatment of thoracic and thoracolumbar spinal tuberculosis: a retrospective case series. J Spinal Disord Tech 2006; 19 (08) 595-602
    CrossrefPubMedGoogle Scholar
  • 32 Shibuya S, Komatsubara S, Yamamoto T, Arima N, Kanda Y, Oka S. Percutaneous discectomy-continuous irrigation and drainage for tuberculous lumbar spondylitis: a report of two cases. Case Rep Med 2009; 2009: 632981
    CrossrefPubMedGoogle Scholar
  • 33 Zhang Z, Hao Y, Wang X. et al. Minimally invasive surgery for paravertebral or psoas abscess with spinal tuberculosis - a long-term retrospective study of 106 cases. BMC Musculoskelet Disord 2020; 21 (01) 353
    CrossrefPubMedGoogle Scholar