Our Summary

Spinal tuberculosis is treated surgically, typically with a procedure that involves cleaning the infected area, reconstructing the spinal stability, relieving pressure on the nerves, and correcting any abnormal curvature of the spine. The most common method to do this has been by operating from the front of the patient. However, this approach can carry a high risk of damaging other organs such as the lungs, heart, kidney, ureter, and bowel. Furthermore, it’s limited in its ability to correct deformity in the spine.

An alternative method is to operate from the back, or “posterior” side of the patient. This has fewer complications as there are fewer organs in the way. It also makes use of a special screw that goes through the spinal structure, providing a stronger force for correcting deformity compared to the screw used in the front approach.

The paper reports the case of a 68-year-old man with spinal tuberculosis who was treated using only the posterior approach. Under general anesthesia, the patient was placed face-down and an incision was made on the midline of his back to expose the spine. The special screw was then placed, and one side was temporarily fixed. The side with more bone damage and a larger abscess was chosen to be cleaned out. The surgeon was careful to protect the spinal cord and nerve root during this process. After the unhealthy tissue was removed, specially designed titanium mesh cages or bone blocks were inserted. Both sides were then fixed and compressed to ensure the cages and bone blocks were tightly fitted. The posterior structure of the spine was then reconstructed using donated and the patient’s own bone.

This approach allows for all necessary procedures to be completed with just one incision and surgical position, and is more effective at correcting deformity than the front approach.

FAQs

  1. What is the traditional approach to treating spinal tuberculosis surgically?
  2. What are the benefits of operating from the back, or “posterior” side of the patient, in spinal tuberculosis surgeries?
  3. How was the posterior approach used in the case of the 68-year-old man with spinal tuberculosis?

Doctor’s Tip

After undergoing spinal fusion surgery, it is important for patients to follow their doctor’s instructions for post-operative care. This may include physical therapy, pain management, and restrictions on certain activities. It is important to give your body time to heal and follow up with your doctor regularly to monitor your progress. Remember to communicate any concerns or unusual symptoms to your healthcare provider. By following these guidelines, you can optimize your recovery and improve the long-term success of your spinal fusion surgery.

Suitable For

Patients who are typically recommended spinal fusion include those with spinal deformities, spinal instability, spinal fractures, degenerative disc disease, spondylolisthesis, and spinal tumors. In the case of spinal tuberculosis, surgical intervention such as spinal fusion may be recommended if conservative treatments such as antibiotics and immobilization are not effective in treating the infection and stabilizing the spine.

Timeline

Before the spinal fusion surgery, the patient likely experienced symptoms such as back pain, weakness, numbness, and difficulty walking due to spinal tuberculosis. They may have undergone diagnostic tests such as X-rays, MRIs, and CT scans to confirm the diagnosis and determine the extent of the infection.

After the surgery, the patient would initially experience pain and discomfort at the surgical site. They would be closely monitored in the hospital for any signs of infection or complications. Physical therapy would begin shortly after the surgery to help the patient regain strength and mobility in the spine. Over the following weeks and months, the patient would continue with physical therapy and gradually increase their activity level.

Ultimately, the goal of spinal fusion surgery is to stabilize the spine, relieve pressure on the nerves, and improve the patient’s overall quality of life. With proper care and rehabilitation, the patient can expect to see improvements in their symptoms and function over time.

What to Ask Your Doctor

  1. What are the risks and potential complications associated with spinal fusion surgery for treating spinal tuberculosis?
  2. How long is the recovery process for this type of surgery, and what can I expect in terms of pain management and rehabilitation?
  3. Are there any alternative treatments or procedures that could be considered for my condition?
  4. How successful is spinal fusion surgery in treating spinal tuberculosis, and what are the long-term outcomes for patients who undergo this procedure?
  5. Will I need to undergo any additional treatments or follow-up procedures after the surgery?
  6. How experienced are you in performing spinal fusion surgery for spinal tuberculosis, and what is your success rate with this procedure?
  7. What can I do to prepare for surgery and optimize my chances for a successful outcome?
  8. Are there any lifestyle changes or modifications that I will need to make after the surgery to support my recovery and overall spinal health?
  9. What are the potential risks and benefits of using the posterior approach for spinal fusion surgery compared to the traditional front approach?
  10. Can you provide me with any additional resources or information to help me better understand the surgical procedure and what to expect during the recovery process?

Reference

Authors: Tang MX, Zhang HQ, Wang YX, Guo CF, Liu JY. Journal: Orthop Surg. 2016 Feb;8(1):89-93. doi: 10.1111/os.12228. PMID: 27028387