Minimally invasive lateral trans-psoas approach for tuberculosis of lumbar spine

Abstract

Anterior, posterolateral and posterior approaches are used for managing lumbar tuberculosis. Minimally invasive methods are being used increasingly for various disorders of the spine. This report presents the utility of lateral trans-psoas approach to the lumbar spine (LS) using minimal access techniques, also known as direct lateral lumbar interbody fusion in 2 cases with tuberculosis of LS. Two patients with tuberculosis at L2-3 and L4-5 presented with back pain. Both had destruction and deformity of the vertebral body. The whole procedure comprising debridement and placement of iliac crest graft was performed using tubular retractors and was augmented by posterior fixation using percutaneous transpedicular screws. Both patients recovered well with no significant procedure related morbidity. Post-operative computed tomography scans showed appropriate position of the graft and instrumentation. At follow-up, both patients are ambulant with no progression of the deformity. Minimal access direct lateral transpsoas approach can be used for debridement and reconstruction of ventral column in tuberculous of Lumbar spine. This paper highlights the growing applications of minimal access surgery for spine.

Key words

Direct lateral lumbar interbody fusion - lateral trans-psoas approach - minimally invasive approach - spondylodiscitis - tuberculosis

• References

• 1 Tuli SM. Tuberculosis of the spine: A historical review. Clin Orthop Relat Res 2007; 460: 29-38
• 2 Pu X, Zhou Q, He Q, Dai F, Xu J, Zhang Z. et al A posterior versus anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberculosis. Int Orthop 2012; 36: 307-313
• 3 Kandwal P, Garg B, Upendra B, Chowdhury B, Jayaswal A. Outcome of minimally invasive surgery in the management of tuberculous spondylitis. Indian J Orthop 2012; 46: 159-164
• 4 Lee BH, Lee HM, Kim TH, Kim HS, Moon ES, Park JO. et al Transpedicular curettage and drainage of infective lumbar spondylodiscitis: Technique and clinical results. Clin Orthop Surg 2012; 4: 200-208
• 5 Hrabalek L, Adamus M, Gryga A, Wanek T, Tucek P. A comparison of complication rate between anterior and lateral approaches to the lumbar spine. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 156: 1-6
• 6 Hanaoka N, Kawasaki Y, Sakai T, Nakamura T, Nanamori K, Nakamura E. et al Percutaneous drainage and continuous irrigation in patients with severe pyogenic spondylitis, abscess formation and marked bone destruction. J Neurosurg Spine 2006; 4: 374-379
• 7 Ito M, Sudo H, Abumi K, Kotani Y, Takahata M, Fujita M. et al Minimally invasive surgical treatment for tuberculous spondylodiscitis. Minim Invasive Neurosurg 2009; 52: 250-253
• 8 Ringel F, Stoffel M, Stüer C, Meyer B. Minimally invasive transmuscular pedicle screw fixation of the thoracic and lumbar spine. Neurosurgery 2006; 59 (04) (Suppl. 02) ONS361-ONS366
• 9 Cheng JS, Park P, Le H, Reisner L, Chou D, Mummaneni PV. Short-term and long-term outcomes of minimally invasive and open transforaminal lumbar interbody fusions: Is there a difference?. Neurosurg Focus 2013; 35: E6
• 10 Ozgur BM, Aryan HE, Pimenta L, Taylor WR. Extreme Lateral Interbody Fusion (XLIF): A novel surgical technique for anterior lumbar interbody fusion. Spine J 2006; 6: 435-443
• 11 Arnold PM, Anderson KK, McGuire Jr RA. The lateral transpsoas approach to the lumbar and thoracic spine: A review. Surg Neurol Int 2012; 3 (Suppl. 03) S198-S215
• 12 Rodgers WB, Gerber EJ, Patterson J. Intraoperative and early postoperative complications in extreme lateral interbody fusion: An analysis of 600 cases. Spine (Phila Pa 1976) 2011; 36: 26-32
• 13 Youssef JA, McAfee PC, Patty CA, Raley E, DeBauche S, Shucosky E. et al Minimally invasive surgery: Lateral approach interbody fusion: Results and review. Spine (Phila Pa 1976) 2010; 35 (26) Suppl S302-S311
• 14 Benglis DM, Elhammady MS, Levi AD, Vanni S. Minimally invasive anterolateral approaches for the treatment of back pain and adult degenerative deformity. Neurosurgery 2008; 63: 191-196
• 15 DeLuzio KJ, Lucio JC, Rodgers WB. Value and cost in less invasive spinal fusion surgery: Lessons from a community hospital. SAS J 2010; 4: 37-40
• 16 Laws CJ, Coughlin DG, Lotz JC, Serhan HA, Hu SS. Direct lateral approach to lumbar fusion is a biomechanically equivalent alternative to the anterior approach: An in vitro study. Spine (Phila Pa 1976) 2012; 37: 819-825
• 17 Zhang H, Huang S, Guo H, Ge L, Sheng B, Wang Y. et al A clinical study of internal fixation, debridement and interbody thoracic fusion to treat thoracic tuberculosis via posterior approach only. Int Orthop 2012; 36: 293-298
• 18 Garg B, Kandwal P, Nagaraja UB, Goswami A, Jayaswal A. Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis: A retrospective analysis. Indian J Orthop 2012; 46: 165-170
• 19 Garg N, Vohra R. Minimally invasive surgical approaches in the management of tuberculosis of the thoracic and lumbar spine. Clin Orthop Relat Res 2014; 472 (06) 1855-1867
• 20 Kim DJ, Yun YH, Moon SH, Riew KD. Posterior instrumentation using compressive laminar hooks and anterior interbody arthrodesis for the treatment of tuberculosis of the lower lumbar spine. Spine (Phila Pa 1976) 2004; 29: E275-E279