Spinal Tuberculoma Surgery

Spinal tuberculoma is rare in tuberculosis in all parts of the body. It is a bloody infection, and patients are often accompanied by other tuberculosis. The incidence rate is high in developing countries and has also occurred in some parts of China. Tumors in the spinal cord are spherical lesions. MRI showed clearer, localized spinal cord enlargement, T1 image of spherical foci was mostly equal signal, which could be ring-enhanced, and the central necrotic area of the cheese showed a low signal; T2 showed a signal around the lesion, and the central necrotic area showed a high signal. That is, the "target sample sign" appears. The elderly with long course of disease may have uneven calcification. The predilection site is the thoracic segment of the spinal cord, with fewer neck segments and lower lumbar segments. Most of the clinical manifestations are numbness and weakness of the limbs, and severe sputum and dysfunction. Because the disease is rare, the clinician is inexperienced, the diagnosis is often delayed, and the spinal cord damage is increasing, which can lead to complete paralysis; if detailed analysis and early diagnosis can be performed, under microsurgical operation, the lesion can be removed, which can reduce disability and obtain Good therapeutic effect. Treatment of diseases: intraductal tuberculosis Indication Spinal tuberculosis surgery is applicable to: 1. The patient's performance is tuberculosis, or there are tuberculosis lesions in other parts. MRI examination showed a small spherical lesion in the spinal cord. The spinal cord function was damaged in Frankel grade C or D. After a sufficient number of anti-tuberculosis drugs for several weeks, the symptoms did not improve and there was a tendency to aggravate. Surgery should be considered. 2, MRI shows that the intramedullary lesions are large, although the anti-tuberculosis drugs, but the limb function has been incompletely developed Frankel B grade or nearly complete a grade A, should strive for early surgery, may retain some of the spinal function. Contraindications The patient has been completely paralyzed (Frankel A grade) for several months, or the tuberculosis has been calcified, the spinal cord has been compressed for a long time, has become thin and atrophy, and the surgery can not work. Preoperative preparation 1. General preparation of the whole body According to the condition and examination, the patient's general condition is actively improved, and various necessary supplements and corrections are given. 2, those with constipation, pre-operative laxatives, enema during the night before surgery. Those with dysuria should be catheterized before surgery and indwelling catheter. 3, neck lesions affect the respiratory, preoperative should be deep breathing, cough and other training, a few days before surgery can start aerosol inhalation, if necessary, antibiotics. 4, postoperative need to prone, should be prone position training in advance, so that patients can adapt to this lying position. 5, sedatives before the operation, phenobarbital 0.1g. 6, fast within 6 ~ 8h before surgery. 7, the day before surgery to prepare the surgical skin, cleaning shaving, the range should be more than 15cm around the incision. Neck surgery should shave the occipital hair. 8. According to the needs of anesthesia, give medication before anesthesia. 9, preoperative positioning should be determined before the scheduled removal of the spine position of the lamina, the easiest way is to locate according to the body surface markers. In the difference of body shape, there may be 1 or 2 spine errors due to the marker positioning. In order to avoid the error, it can be positioned according to the body surface marker, and then a type of lead is glued on the body surface of the corresponding spinous process. After taking the X-ray film, the surgical site is verified from the position of the lead on the X-ray film. 10. Apply anti-tuberculosis drugs streptomycin, isoniazid and rifampin. Surgical procedure 1. Make a dorsal midline incision centering on the lesion, separate the paravertebral muscles on both sides, expose 2 to 3 lamina, and open the surgical field with a retractor. First, the two lamina of the lesion site were removed, and then the dura mater was cut. The lesion showed a spinal cord enlargement, and a surgical microscope was prepared to treat the lesion. 2, lesion resection selected lesions from the thinnest part of the spinal cord surface, or incision in the midline of the spinal cord, first encountered a tough surface of the lesion, before stripping and incision of the lesion, with a cotton thread placed in the spinal cord incision The side protection is good. Once the pus or cheese-like tissue overflows when the lesion is peeled off or cut, it can avoid contaminating the surrounding tissue, and quickly remove the pus or caseous necrotic tissue with the suction device and replace the new aspirator head. Carefully peel off along the surface of the lesion, try to remove the lesion without increasing the spinal cord injury, and repeatedly rinse the area with saline to tightly suture the dura mater. 3, the epidural external rubber film drainage, suture the incision layer by layer. complication 1, spinal epidural hematoma paravertebral muscles, vertebrae and epidural venous plexus hemostasis, hematoma can be formed after surgery, resulting in limb paralysis, more than 72h after surgery. A hematoma can occur even when the drainage tube is placed. If this phenomenon occurs, it should be actively checked to remove the hematoma and completely stop bleeding. 2, spinal edema is often caused by surgical operation of the injured spinal cord, clinical manifestations similar to hematoma. The treatment is mainly dehydration and hormones; in severe cases, the dura mater has been sutured, and the operation can be performed again to open the dura mater. 3, cerebrospinal fluid leakage due to dull suture and / or muscle layer suture is not strict. If there is drainage, it should be removed in advance. If the leakage is less, the dressing is observed. If it cannot be stopped or the fluid is leaked, the leak should be sutured in the operating room. 4, wound infection, cracking is generally poor, incision healing ability or cerebrospinal fluid leakage is easy to occur. Intraoperative attention should be paid to aseptic operation. In addition to antibiotic treatment, it should actively improve the general condition, paying special attention to the supplement of protein and multivitamins. Special parts such as between the shoulder blades should be reinforced with muscle layer sutures. 5, intraoperative pus dissemination caused by tuberculous meningitis, the application of a variety of anti-tuberculosis drugs control.