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Global Reconstruction for Extensive Destruction in Tuberculosis of the Lumbar Spine and Lumbosacral Junction: A Case Report

Study Design Case report. Objective To analyze the surgical difficulties in restoring global spinal stability and to describe an effective surgical option for tuberculosis with extensive destruction of the lumbosacral spine. Advanced tuberculosis with destruction of the lumbosacral spine can result...

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Autores principales: Uvaraj, Nalli R., Bosco, Aju, Gopinath, Nalli R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4516746/
https://www.ncbi.nlm.nih.gov/pubmed/26225288
http://dx.doi.org/10.1055/s-0034-1395780
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author Uvaraj, Nalli R.
Bosco, Aju
Gopinath, Nalli R.
author_facet Uvaraj, Nalli R.
Bosco, Aju
Gopinath, Nalli R.
author_sort Uvaraj, Nalli R.
collection PubMed
description Study Design Case report. Objective To analyze the surgical difficulties in restoring global spinal stability and to describe an effective surgical option for tuberculosis with extensive destruction of the lumbosacral spine. Advanced tuberculosis with destruction of the lumbosacral spine can result in a kyphosis or hypolordosis, leading to back pain, spinal instability, and neurological deficits. The conventional treatment goals of lumbosacral tuberculosis are to correct and prevent a lumbar kyphosis, treat or prevent a neurological deficit, and restore global spinal stability. Instrumentation at the lumbosacral junction is technically demanding due to the complex local anatomy, the unique biomechanics, and the difficult fixation in the surrounding diseased bone. Methods We report a 21-year-old woman with tuberculosis from L1 to S2 with back pain and spinal instability. The radiographs showed a kyphosis of the lumbar spine. The magnetic resonance imaging and computed tomography scans revealed extensive destruction of the lumbar and lumbosacral spine. Spinopelvic stabilization combined with anterior debridement and reconstruction with free fibular strut graft was performed. Results The radiographs at follow-up showed a good correction of the kyphosis and excellent graft incorporation and fusion. Conclusions Anterior column reconstruction with a fibular strut graft helps restore and maintain the vertebral height. Posterior stabilization with spinopelvic fixation can be an effective surgical option for reconstructing the spine in extensive lumbosacral tuberculosis with sacral body destruction, requiring long fusions to the sacrum. It augments spinal stability, prevents graft-related complications, and accelerates the graft incorporation and fusion, thereby permitting early mobilization and rehabilitation. In spinal tuberculosis, antitubercular therapy may have to be prolonged in cases with large disease load, based on the clinicoradiographic and laboratory parameters.
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spelling pubmed-45167462015-08-01 Global Reconstruction for Extensive Destruction in Tuberculosis of the Lumbar Spine and Lumbosacral Junction: A Case Report Uvaraj, Nalli R. Bosco, Aju Gopinath, Nalli R. Global Spine J Article Study Design Case report. Objective To analyze the surgical difficulties in restoring global spinal stability and to describe an effective surgical option for tuberculosis with extensive destruction of the lumbosacral spine. Advanced tuberculosis with destruction of the lumbosacral spine can result in a kyphosis or hypolordosis, leading to back pain, spinal instability, and neurological deficits. The conventional treatment goals of lumbosacral tuberculosis are to correct and prevent a lumbar kyphosis, treat or prevent a neurological deficit, and restore global spinal stability. Instrumentation at the lumbosacral junction is technically demanding due to the complex local anatomy, the unique biomechanics, and the difficult fixation in the surrounding diseased bone. Methods We report a 21-year-old woman with tuberculosis from L1 to S2 with back pain and spinal instability. The radiographs showed a kyphosis of the lumbar spine. The magnetic resonance imaging and computed tomography scans revealed extensive destruction of the lumbar and lumbosacral spine. Spinopelvic stabilization combined with anterior debridement and reconstruction with free fibular strut graft was performed. Results The radiographs at follow-up showed a good correction of the kyphosis and excellent graft incorporation and fusion. Conclusions Anterior column reconstruction with a fibular strut graft helps restore and maintain the vertebral height. Posterior stabilization with spinopelvic fixation can be an effective surgical option for reconstructing the spine in extensive lumbosacral tuberculosis with sacral body destruction, requiring long fusions to the sacrum. It augments spinal stability, prevents graft-related complications, and accelerates the graft incorporation and fusion, thereby permitting early mobilization and rehabilitation. In spinal tuberculosis, antitubercular therapy may have to be prolonged in cases with large disease load, based on the clinicoradiographic and laboratory parameters. Georg Thieme Verlag KG 2014-11-10 2015-08 /pmc/articles/PMC4516746/ /pubmed/26225288 http://dx.doi.org/10.1055/s-0034-1395780 Text en © Thieme Medical Publishers
spellingShingle Article
Uvaraj, Nalli R.
Bosco, Aju
Gopinath, Nalli R.
Global Reconstruction for Extensive Destruction in Tuberculosis of the Lumbar Spine and Lumbosacral Junction: A Case Report
title Global Reconstruction for Extensive Destruction in Tuberculosis of the Lumbar Spine and Lumbosacral Junction: A Case Report
title_full Global Reconstruction for Extensive Destruction in Tuberculosis of the Lumbar Spine and Lumbosacral Junction: A Case Report
title_fullStr Global Reconstruction for Extensive Destruction in Tuberculosis of the Lumbar Spine and Lumbosacral Junction: A Case Report
title_full_unstemmed Global Reconstruction for Extensive Destruction in Tuberculosis of the Lumbar Spine and Lumbosacral Junction: A Case Report
title_short Global Reconstruction for Extensive Destruction in Tuberculosis of the Lumbar Spine and Lumbosacral Junction: A Case Report
title_sort global reconstruction for extensive destruction in tuberculosis of the lumbar spine and lumbosacral junction: a case report
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4516746/
https://www.ncbi.nlm.nih.gov/pubmed/26225288
http://dx.doi.org/10.1055/s-0034-1395780
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