Endoscopic Spine Surgery Center, Dae-Chan Hospital, 590, Inju-daero, Namdong-gu, Incheon, Republic of Korea.
Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
Eur Spine J. 2024 Aug;33(8):3161-3164. doi: 10.1007/s00586-024-08308-4. Epub 2024 Jul 2.
Spinal tuberculosis, if not promptly treated, can lead to kyphotic deformity, causing persistent neurological abnormalities and discomfort. Spinal cord compression can occur due to ossification of the ligamentum flavum (OLF) at the apex of kyphosis. Traditional surgical interventions, including osteotomy and fixation, pose challenges and risks. We present a case of thoracic myelopathy in a patient with post-tuberculosis kyphosis, successfully treated with biportal endoscopic spinal surgery (BESS).
A 73-year-old female with a history of untreated kyphosis presented with walking difficulties and lower limb pain. Imaging revealed a kyphotic deformity of 120° and OLF-induced cord compression at T8-9. UBE was performed under spinal anesthesia. Using the BESS technique, OLF was successfully removed with minimal damage to the stabilizing structures.
The patient exhibited neurological improvement after surgery, walking on the first day without gait instability. Follow-up at 1 year showed no kyphosis progression or recurrence of symptoms. BESS successfully resolved the cord compression lesion with minimal blood loss and damage.
In spinal tuberculosis-related OLF, conventional open surgery poses challenges. BESS emerges as an excellent alternative, providing effective decompression with reduced instrumentation needs, minimal blood loss, and preservation of surrounding structures. Careful patient selection and surgical planning are crucial for optimal outcomes in endoscopic procedures.
如果不及时治疗，脊柱结核可能导致脊柱后凸畸形，导致持续的神经功能异常和不适。脊柱后凸的顶点处黄韧带骨化（OLF）可能导致脊髓受压。传统的手术干预，包括截骨和固定，存在挑战和风险。我们报告了一例脊柱结核后凸患者的胸椎脊髓病，采用双端口内窥镜脊柱手术（BESS）成功治疗。
一名 73 岁女性，有未治疗的后凸病史，出现行走困难和下肢疼痛。影像学显示 120°的后凸畸形和 T8-9 处 OLF 引起的脊髓压迫。在脊髓麻醉下进行 UBE。采用 BESS 技术，最小程度地损伤稳定结构，成功切除 OLF。
术后患者神经功能改善，第一天即可行走，无步态不稳。1 年随访时无后凸进展或症状复发。BESS 成功解决了脊髓压迫病变，出血量和损伤较小。
在脊柱结核相关的 OLF 中，传统的开放性手术存在挑战。BESS 是一种很好的替代方法，提供了有效的减压，减少了器械的需要，出血量小，周围结构得到了保护。对于内窥镜手术，仔细的患者选择和手术计划对于获得最佳结果至关重要。
