RETROPERITONEAL LAPAROSCOPIC APPROACH COMBINED WITH ANTEROLATERAL MINI-INCISION FOR LUMBAR SPINE TUBERCULOSIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHENRongchun ,  CHENYunsheng , ZENGYunfeng , GUOChaoyang , CHENQin , LIMingheng

Department of Spinal Surgery, the People's Hospital of Ganzhou Affiliated to Nanchang University, Ganzhou Jiangxi, 341000, P. R. China;

Corresponding?author：

CHENYunsheng, Email: cysheng2006@sina.com

Keywords：

Laparoscope; Anterolateral mini-incision; Retroperitoneal approach; Lumbar tuberculosis

DOI：

10.7507/1002-1892.20140295

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the effectiveness of retroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis. Methods A retrospective analysis was made on the cl inical data of 22 patients with lumbar spine tuberculosis undergoing focus clearance, fusion, and internal fixation by retroperitoneal laparoscopic approach combined with anterolateral mini-incision between June 2006 and June 2012. There were 14 males and 8 females, with an average age of 42.6 years (range, 26-57 years) and with a mean disease duration of 7.3 months (range, 3-10 months). There were 17 patients with single-level spinal tuberculosis (L_{1, 2} in 3, L_{2, 3} in 6, L_{3, 4} in 4, L_{4, 5} in 2, and L₅ in 2) and 5 patients with double-level spinal tuberculosis (L_1-3 in 2 and L_2-4 in 3). The preoperative Cobb's angle of lumbar spine was 5-28° (mean, 20°). In 6 patients having compression symptom, 4 cases were rated as grade D and 2 as grade C according to Frankel classification. The operative time, intraoperative blood loss, and postoperative complications were recorded. At last follow-up, the neurologic function was assessed according to Frankel grade, the Cobb's angle after operation was measured on lumbar lateral X-ray film; the efficacy was evaluated according to Nakai criteria, and the fusion was evaluated according to Suk criteria. Results All operations were successfully completed. The operation time was 110-250 minutes (mean, 140 minutes), and intraoperative blood loss was 120-280 mL (mean, 180 mL). The symptoms of femoral nerve injury and sympathetic nerve injury occurred in 1 case respectively and was relieved at 1-3 weeks after operation. All incisions healed by first intention. The patients were followed up 16-50 months (mean, 21 months). During the follow-up period, no loosening or breakage of implants and no tuberculosis recurrence were found. At last follow-up, the nerve function was recovered to grade E in the others except 1 case at grade D. The Cobb's angle was 2-16° (mean, 7.8°). According to Nakai criteria for efficacy evaluation, the results were excellent in 9 cases, good in 10 cases, and fair in 3 cases, with an excellent and good rate of 86.4%. The bony fusion rate was 95.5% (21/22) according to Suk criteria. Conclusion Retroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis is a safe and effective approach with minimal invasion and less complications.

Citation： CHENRongchun, CHENYunsheng, ZENGYunfeng, GUOChaoyang, CHENQin, LIMingheng. RETROPERITONEAL LAPAROSCOPIC APPROACH COMBINED WITH ANTEROLATERAL MINI-INCISION FOR LUMBAR SPINE TUBERCULOSIS. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(11): 1364-1367. doi: 10.7507/1002-1892.20140295 Copy

1.	Obenchain TG. Laparoscopic lumbar disectomy:case report. J Laparoendoscopic Surg, 1991, 1(3):145-149.
2.	Zdeblick TA, David SM. A prospective comparison of surgical approach for anterior L4-L5 fusion:laparoscopic versus mini anteriorlumbar interbody fusion. Spine (Phila Pa 1976), 2000, 25(20):2682-2687.
3.	王冰, 呂國華, 馬澤民, 等.腹腔鏡輔助與小切口技術行前路L4/5椎間融合術的比較.中國脊柱脊髓雜志, 2007, 17(5):341-345.
4.	Nakai O, Ookawa A, Yamaura I. Long-term roentgenographic and functional change in patients who were treated with wide fenestration for central lumbar stenosis. J Bone Joint Surg (Am), 1991, 73(8):1184-1191.
5.	Suk SI, Lee CK, Kim WJ, et al. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterlateral fusion after decompression in spondylolytic spondylolisthesis. Spine (Phila Pa 1976), 1997, 22(2):210-220.
6.	郭立新, 陳興, 馬遠征, 等.病灶切除植骨與椎弓根固定治療脊柱結核.中華醫學雜志, 2002, 82(16):1121-1123.
7.	金大地, 陳建庭, 張浩, 等.一期前路椎體間植骨并內固定治療胸腰椎結核.中華外科雜志, 2000, 38(12):900-902, I049.
8.	王錫陽, 周炳炎, 李偉偉, 等.脊柱結核手術治療的并發癥原因分析及防治.中國脊柱脊髓雜志, 2010, 20(12):993-997.
9.	呂國華, 王冰, 黎菲文.腹腔鏡下腰椎前路手術入路的解剖學實驗研究.中國脊柱脊髓雜志, 2003, 13(9):558-561.
10.	陸聲, 鐘世鎮, 徐永清, 等.下腰椎側前方靜脈的解剖及其在腹腔鏡腰椎手術中的臨床意義.中國臨床解剖學雜志, 2006, 24(2):125-127.
11.	陳云生, 游輝, 陳榮春, 等.胸腔鏡輔助下前路病灶清除植骨內固定治療胸椎結核.中國矯形外科雜志, 2011, 19(3):184-187.
12.	Breda A, Finelli A, Janetschek G, et al. Complications of laparoscopic surgery for renal masses:prevention, management, and comparision with the open experience. Eur Urol, 2009, 55(4):836-850.
13.	Chen LH, Lai PL, Tai CL, et al. The effect of interspinous ligament integrity on adjacent segment instabil ity after lumbar instrumentation and laminectomy-an experimental study in porcine model. Biomed Mater Eng, 2006, 16(4):261-267.
14.	Shunwu F, Xing Z, Fengdong Z, et al. Minimally invasive transforminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine (Phila Pa 1976), 2010, 35(17):1615-1620.
15.	張朝躍, 李小如, 張茂祖, 等.借助腹腔鏡行腰椎結核病灶清除術.中國內鏡雜志, 2001, 7(2):36-37.
16.	陳明, 韓智敏, 周揚, 等.經腹直肌腹膜外入路在下腰椎結核治療中的應用.中國脊柱脊髓雜志, 2014, 24(1):58-62.
17.	Wang Z, Wu Q, Geng G. Anterior debridement and bone grafting with posterior single segment internal fixation for the treatment of momosegmental spinal tuberculosis. Injury, 2013, 44(2):253-257.

1. Obenchain TG. Laparoscopic lumbar disectomy:case report. J Laparoendoscopic Surg, 1991, 1(3):145-149.
2. Zdeblick TA, David SM. A prospective comparison of surgical approach for anterior L4-L5 fusion:laparoscopic versus mini anteriorlumbar interbody fusion. Spine (Phila Pa 1976), 2000, 25(20):2682-2687.
3. 王冰, 呂國華, 馬澤民, 等.腹腔鏡輔助與小切口技術行前路L4/5椎間融合術的比較.中國脊柱脊髓雜志, 2007, 17(5):341-345.
4. Nakai O, Ookawa A, Yamaura I. Long-term roentgenographic and functional change in patients who were treated with wide fenestration for central lumbar stenosis. J Bone Joint Surg (Am), 1991, 73(8):1184-1191.
5. Suk SI, Lee CK, Kim WJ, et al. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterlateral fusion after decompression in spondylolytic spondylolisthesis. Spine (Phila Pa 1976), 1997, 22(2):210-220.
6. 郭立新, 陳興, 馬遠征, 等.病灶切除植骨與椎弓根固定治療脊柱結核.中華醫學雜志, 2002, 82(16):1121-1123.
7. 金大地, 陳建庭, 張浩, 等.一期前路椎體間植骨并內固定治療胸腰椎結核.中華外科雜志, 2000, 38(12):900-902, I049.
8. 王錫陽, 周炳炎, 李偉偉, 等.脊柱結核手術治療的并發癥原因分析及防治.中國脊柱脊髓雜志, 2010, 20(12):993-997.
9. 呂國華, 王冰, 黎菲文.腹腔鏡下腰椎前路手術入路的解剖學實驗研究.中國脊柱脊髓雜志, 2003, 13(9):558-561.
10. 陸聲, 鐘世鎮, 徐永清, 等.下腰椎側前方靜脈的解剖及其在腹腔鏡腰椎手術中的臨床意義.中國臨床解剖學雜志, 2006, 24(2):125-127.
11. 陳云生, 游輝, 陳榮春, 等.胸腔鏡輔助下前路病灶清除植骨內固定治療胸椎結核.中國矯形外科雜志, 2011, 19(3):184-187.
12. Breda A, Finelli A, Janetschek G, et al. Complications of laparoscopic surgery for renal masses:prevention, management, and comparision with the open experience. Eur Urol, 2009, 55(4):836-850.
13. Chen LH, Lai PL, Tai CL, et al. The effect of interspinous ligament integrity on adjacent segment instabil ity after lumbar instrumentation and laminectomy-an experimental study in porcine model. Biomed Mater Eng, 2006, 16(4):261-267.
14. Shunwu F, Xing Z, Fengdong Z, et al. Minimally invasive transforminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine (Phila Pa 1976), 2010, 35(17):1615-1620.
15. 張朝躍, 李小如, 張茂祖, 等.借助腹腔鏡行腰椎結核病灶清除術.中國內鏡雜志, 2001, 7(2):36-37.
16. 陳明, 韓智敏, 周揚, 等.經腹直肌腹膜外入路在下腰椎結核治療中的應用.中國脊柱脊髓雜志, 2014, 24(1):58-62.
17. Wang Z, Wu Q, Geng G. Anterior debridement and bone grafting with posterior single segment internal fixation for the treatment of momosegmental spinal tuberculosis. Injury, 2013, 44(2):253-257.

Chinese Journal of Reparative and Reconstructive Surgery

RETROPERITONEAL LAPAROSCOPIC APPROACH COMBINED WITH ANTEROLATERAL MINI-INCISION FOR LUMBAR SPINE TUBERCULOSIS

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content