Tobing Singkat Dohar Apul Lumban, Kurniawan Dody
Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Resident of Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Int J Surg Case Rep. 2020;72:271-276. doi: 10.1016/j.ijscr.2020.04.007. Epub 2020 May 19.
Spinal tuberculosis usually affects the thoracolumbar spine, with only 2-3% involving the lumbosacral region. Lumbosacral tuberculosis can lead to the formation of a presacral abscess. For drainage of the spinal abscess, the presacral region is one of the problematic regions to perform. Minimally invasive surgery (MIS) is an essential clinical technique for the debridement of the spinal abscess in order to decrease the morbidity acquired by the patient. We presented a case of lumbosacral tuberculosis treated with abscess evacuation using the MIS technique.
A 28-year-old male came with the chief complaint of back pain and a lump in the right groin area for four months before admission. Physical examination showed a lump and bilateral positive straight leg raising. Preoperative Oswestry Disability Index (ODI) and the Japanese Orthopaedic Association (JOA) scores showed moderate disability and normal function, respectively. Radiologic examinations showed signs of lumbosacral tuberculosis. The patient underwent abscess evacuation using MIS of presacral approach as described for axial lumbar interbody fusion (AxiaLIF), and improvement in ODI score was noted.
A presacral approach, as what we performed, is a simple approach that can reach the location of the abscess by using fluoroscopic guidance. Abscess evacuation was confirmed by the presence of clear fluid, which indicated that the caseous material had been removed thoroughly, and also, as the clear fluid was no longer noticed.
The success of this approach depends on the time of surgery. When surgery is delayed, the granulation tissue has been formed, making minimally invasive techniques for surgical evacuation much more difficult.
脊柱结核通常累及胸腰段脊柱，仅有2% - 3%累及腰骶部。腰骶部结核可导致骶前脓肿形成。对于脊柱脓肿的引流，骶前区域是手术操作的难题之一。微创手术（MIS）是脊柱脓肿清创的重要临床技术，以降低患者的发病率。我们报告了一例采用MIS技术进行脓肿清除治疗的腰骶部结核病例。
一名28岁男性因背痛和右腹股沟区肿块入院前4个月就诊。体格检查发现肿块及双侧直腿抬高试验阳性。术前Oswestry功能障碍指数（ODI）和日本骨科协会（JOA）评分分别显示中度功能障碍和功能正常。影像学检查显示腰骶部结核征象。患者采用如轴向腰椎椎间融合术（AxiaLIF）所述的经骶前入路MIS进行脓肿清除，ODI评分有所改善。
如我们所采用的经骶前入路是一种简单的方法，可在透视引导下到达脓肿部位。通过有清亮液体流出证实脓肿已清除，这表明干酪样物质已被彻底清除，而且，当不再有清亮液体流出时也可证实。
该方法的成功取决于手术时机。手术延迟时，肉芽组织已经形成，使手术微创清除技术更加困难。
