Thoracic Tuberculosis The Posterior Lesions Cleanup Bone Graft Retention Lamina Fusion

Objective:to introduce a new surgical technology to treat thoracic tuberculosis associated with para-vertebral abscess, debriding the lesion without resect the vertebral lamina.Background material:traditional surgical treatment of thoracic tuberculosis was to curettage the tuberculosis lesion and para-vertebral abscess through posterior approach with the vertebral lamina resected. However, since tuberculosis was a kind of lesion to destruct the spinal stability and, rather, need repaired stability to cure, resecting the vertebral plate decreased the stability of the spine further. As a result, this would increase the possibility of rapture and failure of instruments. Thus, leaving the vertebral plate unresected could hence the spinal stability needing to be repaired and reconstructed, then decrease the occurrence of rapture and failure of instrumentation. This surgical technology was totally new and worth to be generalized.Material and method:surgical treatment of thoracic tuberculosis without resecting the vertebral lamina could be applied to patients with complete lamina not eroded by the tuberculosis lesion. First perform the costotransversectomy at the side of the tuberculosis lesion with pedicle screw placed in the lesion region. Then debride the lesion through posterior approach. Decompress the spinal canal through intervertebral foramina. At last graft the bone at the lesion area at both anterior and posterior. The anti-tuberculosis drug administration should last for more than one year from the surgery.Result:at the final follow up, no rapture and loosen was observed, the lesion did not progressed, the neural deficit improved without complications occurred.Conclusion:surgical treatment of thoracic tuberculosis without resecting the vertebral lamina could cure thoracic tuberculosis safely and effectively, with lesser trauma, lesser blood loss, better post-operational stability, quicker post-operative convalescence, without more complications than traditional methods, albeit more complex and needing more dexterity.