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| TANG Yong,SHEN Huiyong,GAO Liangbin.Retroperitoneal laparoscopic surgery for lumbar spine tuberculosis[J].Chinese Journal of Spine and Spinal Cord,2012,(9):775-778. |
| Retroperitoneal laparoscopic surgery for lumbar spine tuberculosis |
| Received:February 18, 2012 Revised:July 29, 2012 |
| English Keywords:Lumbar tuberculosis Surgery Laparoscopy Retroperitoneal space |
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| English Abstract: |
| 【Abstract】 Objectives: To investigate the outcome of balloon-assisted laparoscopic retroperitoneal approach for lumbar spine tuberculosis. Methods: From October 2009 to October 2011, 16 cases of lumbar tuberculosis underwent balloon-assisted laparoscopic retroperitoneal approach. There were 5 females and 11 males with a mean age of 38.2 years(range, 26-62). The diseased levels included L1-L2 in 2 patients, L2-L3 in 5 patients, L3-L4 in 4 patients, L2-L4 in 2 patients, L3-L5 in 1 patient, L3 in 1 patient and L4 in 1 patient. All patients presented with paraspinal abscesses, and unilateral abscesses in 12 patients and bilateral abscesses in 4 patients. Lumbar kyphosis was noted in 12 patients with a mean sagittal Cobb′s angle of 11.2°±3.6°(5°-20°) before operation. According to ASIA scale, there were 1 grade D and 1 grade C. Anterior debridement, decompression, auto bone graft and one-stage posterior instrumentation under conventional laparoendoscopic approach was performed in 5 patients. One-stage anterior debridement, bone graft and anterior single rod instrumentation for 1 level under LESS technique was performed in 9 patients. Modified LESS technique(one-stage anterior debridement, bone graft and single rod instrumentation for 2-levels) was performed in 2 patients. The standard chemotherapy including isoniazid, rifampicin, pyrazinamide and streptomycin was administered for 2 weeks before operation, and continued for 2 months and followed by rifampicin/INH for 9-12 months. Results: The mean operation time was 280min(240-365min), and the mean intraoperative blood loss was 112ml(50-400ml). Patients were followed up for 3-22(average 12.1) months. ASIA grade revealed good recovery(ASIA E) of patients with neurological deficit. Complications included screw loosening at the L5 level, and removed 3 months after operation and presented with temporal sympathetic nerve dysfuntion. The mean sagittal Cobb′s angle increased significantly to -5.1°±2.7°(P<0.01) 2 weeks after operation, with the mean correction of 15.7°±5.1°. At final follow-up, the mean sagittal angle was -4.2°±2.1°(P<0.01), with the loss of correction of 2.6°±1.8°. 11 patients had a radiographic bony fusion in a time of 6-12 months. No tuberculosis recurrence was found at final follow-up. Conclusions: Laparoscopic retroperitoneal approach is safe and reliable for lumbar spine tuberculosis. |
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