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