Spinal TB Treatment and Approaches

If Deformity and disease activity both present then treat deformity as well as medically.


In general ,

Treatment

 Rest, Nutrition

 Chemotherapy

 Traction

  Surgery
Thoracic Spine -  Approach - A bit ambiguous, many options are there.

Anterior Transpleural ,Anterolateral  extrapleural and posterolateral


Posterolateral approach (Martin 1970 ) -Dura exposed by hemilaminectomy first and then operation

extended  laterally to remove posterior ends of 2-4 ribs, corresponding transevese process and

pedicles. He thinks anterolateral approach risky.


Approach to Atlanto-occipital and Atlanto-axial joint 

- numerous structures on the way anteriorly.

-supine - 5 to 10 degrees hyperextension , tracheostomy done .

Transoral Anterior Approach

- uvula, soft palate , bissected hypopharynx packed, 5 cm incision given and flaps raised. Apply stay

   sutures. Then anterior arch of atlas , body of axis and atlantoaxial joint exposed .

Anterior approach to spine 
Dorsal Spine - trasnpleural anterior approach (trasnthroacic / transsternal )

                         Extra-pleural Anterolateral (Costotransversesctomy )

Lumbar Spine - 
  
                          Retroperitoneal (Renal angle, Rectus Abdominis )

                         Posterior 

                          Transperitoneal (Linea alba , perotineum, bowel )

Posterior approach - Errector Spine -


                                                  Superior - Lateral Dorsi

                                                  Deep

                                                             Superior -sacrospinalis
                                                             Deep  - multifidus and rotators





parts of human ribs = head , neck , body , angle , costal groove , tubercle for articulation with vertebra







Comments

Popular posts from this blog

Outline of Treatment of Spinal Tuberculosis

COXA VARA

Paediatric Supracondylar Humerus Fracture

Timing and Outcome of Surgery in Hip Fractures

Hind Foot amputation