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：

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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, 吕国华, 马泽民, 等.腹腔镜辅助与小切口技术行前路L4/5椎间融合术的比较.中国脊柱脊髓杂志, 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, 陈兴, 马远征, 等.病灶切除植骨与椎弓根固定治疗脊柱结核.中华医学杂志, 2002, 82(16):1121-1123.
7.	金大地, 陈建庭, 张浩, 等.一期前路椎体间植骨并内固定治疗胸腰椎结核.中华外科杂志, 2000, 38(12):900-902, I049.
8.	王锡阳, 周炳炎, 李伟伟, 等.脊柱结核手术治疗的并发症原因分析及防治.中国脊柱脊髓杂志, 2010, 20(12):993-997.
9.	吕国华, 王冰, 黎菲文.腹腔镜下腰椎前路手术入路的解剖学实验研究.中国脊柱脊髓杂志, 2003, 13(9):558-561.
10.	陆声, 钟世镇, 徐永清, 等.下腰椎侧前方静脉的解剖及其在腹腔镜腰椎手术中的临床意义.中国临床解剖学杂志, 2006, 24(2):125-127.
11.	陈云生, 游辉, 陈荣春, 等.胸腔镜辅助下前路病灶清除植骨内固定治疗胸椎结核.中国矫形外科杂志, 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.	张朝跃, 李小如, 张茂祖, 等.借助腹腔镜行腰椎结核病灶清除术.中国内镜杂志, 2001, 7(2):36-37.
16.	陈明, 韩智敏, 周扬, 等.经腹直肌腹膜外入路在下腰椎结核治疗中的应用.中国脊柱脊髓杂志, 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, 吕国华, 马泽民, 等.腹腔镜辅助与小切口技术行前路L4/5椎间融合术的比较.中国脊柱脊髓杂志, 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, 陈兴, 马远征, 等.病灶切除植骨与椎弓根固定治疗脊柱结核.中华医学杂志, 2002, 82(16):1121-1123.
7. 金大地, 陈建庭, 张浩, 等.一期前路椎体间植骨并内固定治疗胸腰椎结核.中华外科杂志, 2000, 38(12):900-902, I049.
8. 王锡阳, 周炳炎, 李伟伟, 等.脊柱结核手术治疗的并发症原因分析及防治.中国脊柱脊髓杂志, 2010, 20(12):993-997.
9. 吕国华, 王冰, 黎菲文.腹腔镜下腰椎前路手术入路的解剖学实验研究.中国脊柱脊髓杂志, 2003, 13(9):558-561.
10. 陆声, 钟世镇, 徐永清, 等.下腰椎侧前方静脉的解剖及其在腹腔镜腰椎手术中的临床意义.中国临床解剖学杂志, 2006, 24(2):125-127.
11. 陈云生, 游辉, 陈荣春, 等.胸腔镜辅助下前路病灶清除植骨内固定治疗胸椎结核.中国矫形外科杂志, 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. 张朝跃, 李小如, 张茂祖, 等.借助腹腔镜行腰椎结核病灶清除术.中国内镜杂志, 2001, 7(2):36-37.
16. 陈明, 韩智敏, 周扬, 等.经腹直肌腹膜外入路在下腰椎结核治疗中的应用.中国脊柱脊髓杂志, 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

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