目标:脊柱结核,如果不及时治疗,会导致后凸畸形,导致持续的神经系统异常和不适。脊髓压缩可能是由于后凸顶点的黄韧带(OLF)骨化而发生的。传统的外科干预措施,包括截骨和固定术,带来挑战和风险。我们介绍了一例患有结核后脊柱后凸的患者的胸椎脊髓病,成功治疗与双门镜脊柱手术(BESS)。
方法:一名73岁女性,有未经治疗的后凸畸形病史,表现为行走困难和下肢疼痛。成像显示120°的后凸畸形和T8-9时OLF引起的脐带压迫。在脊髓麻醉下进行UBE。使用BESS技术,OLF成功移除,对稳定结构的损害最小。
结果:患者在手术后表现出神经系统的改善,在没有步态不稳定的第一天行走。随访1年,无脊柱后凸进展或症状复发。BESS成功解决了脊髓压迫病变,并减少了失血和损伤。
结论:在脊柱结核相关的OLF中,传统的开放手术提出了挑战。BESS成为一个很好的选择,提供有效的减压,减少仪器需求,最小的失血,和周围结构的保护。仔细的患者选择和手术计划对于内窥镜手术的最佳结果至关重要。
OBJECTIVE: 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).
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.