anterolateral spinal canal decompression

Anterior and posterior decompression of the spinal canal for the treatment of spinal tuberculosis with paraplegia. Spinal tuberculosis combined with paraplegia can be divided into two categories: paraplegia occurs in the stage of spinal tuberculosis, ie, paraplegia occurs early; occurs in the quiescent period of spinal tuberculosis or has been basically cured, that is, paraplegia that occurs late. The former is a disease-active type, and the early decompression surgery has a better decompression effect and is easy to recover after surgery. The latter has a poor surgical effect and is slow or difficult to recover after surgery. Some patients not only reduce paraplegia but also aggravate, but may be related to stimulation of spinal cord caused by spinal cord edema or circulatory disorder. After spinal cord edema subsides, paraplegia gradually recovers, but some cases still recover to the preoperative level, thus the bone Non-surgical treatment should be used as much as possible for paralyzed paraplegic patients. Surgical treatment should be performed in children with anterior decompression of the spinal cord, which can achieve the purpose of treatment and reduce the damage to the stability of the spine. For the multi-segmental tuberculosis of the spine, the lesions causing paraplegia should be treated first. The severity of the multi-segment tuberculosis lesions is similar. If it cannot be solved by one operation, it should be based on the principle of first going up and down. For patients with severe vertebral destruction, interbody fusion should be used. Because the lamina grafting has little effect on preventing the progression of kyphosis. Treating diseases: spinal tuberculosis Indication Anterior and posterior decompression of the spinal canal is suitable for vertebral tuberculosis in adult thoracic or thoracolumbar segments with severe paraplegia. Preoperative preparation It is safer to use an endotracheal intubation for general anesthesia. If the patient's physical condition is poor, local infiltration anesthesia is also feasible. However, preparation for conscious intubation is required. Lateral position, the operation side is on the upper side, generally the paraplegia is heavier, the vertebral body is more damaged, and the larger side of the paraspinal abscess is the operation side. Surgical procedure 1. Incision, with a curved incision centered on the lesion, the length of the incision should include 6 transverse processes. The midpoint of the arc is about 8 cm from the vertebral spinous process. Cut the skin and subcutaneous tissue and open the flap in the deep fascia. 2. Transect the sacral spine muscle and pull it up and down to reveal the distal end of the 4 lamina and transverse process on the surgical side, and then remove the 4 transverse processes in the middle. Then remove the posterior segment of the rib connected to the diseased vertebra, free the intercostal nerve, ligature the intercostal vascular branch, and use the periosteal stripper to detach the pedicle to the periosteum of the anterior border of the vertebral body to enter the lesion. 3. Suck the pus and scrape the cheese-like material and dead bones. Fill with gauze and compress. The spinal canal wall is then removed. The intervertebral foramen were exposed, and the nerve roots of the pedicle were separated by nerve strippers. Use a sharp-nose rongeur to bite off the pedicle and reveal the side of the spinal cord. 4. Use a nerve stripper to separate the dura mater from the anterior compression material. These substances may be necrotic disc tissue or stenotic sclerotic bone. If the bone is hard, under the protection of the nerve stripper, the ulnar bone is removed with a trephine. A thin layer of bone remaining in front of the spinal canal can be carefully bitten with a rongeur. It can also move forward to reach the decompression in front of the spinal cord. Use as little chisel as possible to avoid irritating the spinal cord. 5. Rinse the wound repeatedly, grooving the upper and lower edges of the vertebral body, and using the resected ribs to perform anterior lumbar bone grafting. 6. After the local anti-tuberculosis drugs are placed, the wounds are sutured in layers. complication 1. Pleural tears occur more often when the rib periosteum is removed. 2. The symptoms of paraplegia are aggravated. 3. Cerebrospinal fluid leakage.