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
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
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