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KMID : 0376219850220010163
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Chonnam Medical Journal
1985 Volume.22 No. 1 p.163 ~ p.172
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Retropleural-Retroperitoneal Approach for Spinal Tuberculosis at the Thoracolumbar Junction
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Abstract
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Recently the incidence of spinal tuberculosis has decreased remarkably throughout the world, owing to the development of chemotherapeutics and more aggressive surgical approaches.
The thoracolumbar junction is a relatively frequent site of spinal tuberculosis, and surgical access is difficult because of the diaphragm. Biomechanically the highest torsional stiffness is typically exhibited at the thoracolumbar junction. This makes the T12-L1 motion segment the site of stress concenteration. Thoracolumbar junction stability is extremely important in maintaining entire spinal stability.
A total of 34 cases of tuberculous spondylitis of the thoracolumbar junction were treated by anterior decompression and interbody fusion through the retropleural-retroperitoneal route from March, 1979 to January, 1985. The postoperative course was uneventful and complications were minimal in most.
The retropleural-retroperitoneal approach seems to offer the following advantages over all the others: lesser risk, no limitation of surgical field, less chance of contaminating the pleural cavity, less postoperative complications and less cumbersome immediate postoperative care. This approach is also useful in the treatment of other kinds of infection, tumor, spinal deformities, H.N.P. and fracture-dislocations at the thoracolumbar junction.
The clinical experience gained in this study leads us to conclude that the retropleural-retroperitoneal approach for tuberculous spondylitis of thoracolumbar junction is the method of choice, and recommended especially in poor risk patients.
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