Rectus abdominis extraperitoneal approach for lower lumbar spinal tuberculosis

English Keywords:Extraperitoneal approach  Rectus abdominis  Lower lumbar tuberculosis  Treatment

English Abstract:

  【Abstract】 Objectives: To evaluate the surgical outcome of rectus abdominis extraperitoneal approach for lower lumbar spinal tuberculosis. Methods: From September 2008 to January 2013, 15 cases with lower lumbar spinal tuberculosis underwent this surgery. The rectus abdominis was pulled to one side, lumbar vertebra was exposed from the medial edge of the psoas muscle via rectus abdominis extraperitoneal approach. The involved vertebra as well as the lesion was exposed under fluoroscopy. Debridement and removal of dead bone was performed. After that, instrumentation was applied in 10 cases. The mean operation time and the average blood loss, erythrocyte sedimentation rate(ESR) and C-reactive protein were recorded before and after surgery. The rate of correction of Cobb′s angle before and after surgery and fusion status were evaluated by radiography. Efficacy was evaluated according to Chen criteria. Results: All cases were followed up for 6 to 52 months. The mean operation time was 120 minutes and the average blood loss was 300ml for cases undergoing anterior approach alone. The average operation time was 256 minutes and the average blood loss was 380ml for cases undergoing anterior and posterior approach. ESR and C-reactive protein decreased to normal level 2 to 4 weeks after operation in all cases. The average kyphosis correction was 16° in cases with combined approach. All cases reached bony fusion 4 to 6 months after operation. According to Chen criteria for efficacy evaluation, excellent was noted in 10 cases, good in 4 cases, fair in 1 case, with a good rate of 93.3%. Conclusions: The rectus abdominis extraperitoneal approach is minimal invasive and simple, and worthy of clinical application for lower lumbar spinal tuberculosis.