ONE YEAR FOLLOW UP

ON HYBRID SYSTEM IN
SPINAL TUBERCULOSIS
SURGERY: A CASE
REPORT
Department Orthopaedic and Traumatology
Faculty of Medicine, Universitas Indonesia
Cipto Mangunkusumo Hospital

INTRODUCTION

Spondylitis TB
leads to the instability of the spine due to damage to
the corpus and makes neurologic deficit. 1,2

New Procedures
conventional technique and minimally invansive
technique (Hybrid System) allows minimal incisions only at the level of
pathologic vertebrae3,4

Aim of study
to asses outcomes of minimally invansive technique in
the surgical treatment of spondylitis TB
1.
2.
3.

4.

Kandwal P, Garg B, Upendra B, Jayaswal A. Outcome of minimally invansive surgery in the management of tuberculous
spondylitis. Indian J Orthop. 2012;46:159-64.
Rigotti S, et al. Minimally invansive posterior stabilization for treating spinal tuberculosis. J Orthopaed Traumatol. 2013;14:143-5.
Hanaoka N, Kawasaki Y, Sakai T, Nakamura T, Nanamori K, Nakamura E, Uchida K, Yamada H. Percutaneous drainage and
continuous irrigation in patients with severe pyogenic spondylitis, abscess formation, and marked bone destruction. J
Neurosurg Spine. 2006;4: 374-9.
Ito M, Sudo H, Abumi K, Kotani Y, Takahata M, Fujita M, Minami A. Minimally invasive surgical treatment for tuberculous
spondylodiscitis. Minim Invasive Neurosurg.2009; 52: 250253.

METHODS

A female, 26 yo, with diagnosis spondylitis TB at the level Th12-L1 and L4L5

Indication of surgery were back pain + neurologic deficit and progressive

paraspinal abscess

Treated by posterior spine stabilization with mini open posterolateral

debridement + fusion + percutaneous abscess drainage

Evaluated : blood loss, duration of surgery, length of stay, Visual Analogue

Scale (VAS) scores, fusion status, neurological state and Oswetry Disability
Index (ODI)

CASE ILLUSTRATION

Chief complain : back pain radiating to the right hip since 6 months ago

History of tuberculosis, currently on anti tuberculosis regimens at the 4 th

months

PHYSICAL EXAMINATION

Tenderness on Th12-L1(VAS 7-8)

No gibbus or sinus

Hypesthesia at right L1 dermatome

Abscess paraspinal

No motoric disturbance

X RAY
-

Erosion on Th12-L1
spinal body
- Discal narrowing

- Fusiformic shadow at right

paravertebral Th7-S2

Lytic lesion,inferioranterior of L4

MRI

STABILIZATION

Posterior stabilization
approach
1 cm incision on 8 places
8 pedicle screws, size
55-40 (Th11-12) and 65-40
(L2-3)
2 Rods, 90 cm length
C-Arm guided
ILLICO MIS (Scientix)

ABSCESS DRAINAGE

Aspiration using 10cc syringe

for validation
1,5 cm incision was made
Around 700cc of casseous pus
was suctioned from the
abscess cavity
Drain was left

POST OPERATIVE

Drain was released at the

3rd day (total drain
production was 100cc)

At the 5th day patient was

discharged. At the day,
VAS was 3-4 (from 7-8), and
patient can walk normally

Anti-tuberculosis regimen
was continued 8 months
after the surgery (total was
12 months of regimen)

FOLLOW UP

One year follow up

RESULT

DISCUSSION

Minimal invasive surgery has been providing an alternative that may

decrease the morbidity caused by open surgeries 1,2

Intraoperative blood loss was 150cc. This is less than blood loss from
posterior stabilization, which range from 200-800cc. Shorter length stay
(10 days to 5 days) `1

On follow up, good fusion was achieved. VAS and ODI score were
improved in 6 moths and better in 12 months clinically patient became
better

This case report had same result as Rigotti et al: in overall, minimally
invasive spine surgery produced a good outcome for spondylitis tb cases 2

1.
2.

Kandwal P, Garg B, Upendra B, Jayaswal A. Outcome of minimally invansive surgery in the

management of tuberculous spondylitis. Indian J Orthop. 2012;46:159-64.
Rigotti S, et al. Minimally invansive posterior stabilization for treating spinal tuberculosis. J
Orthopaed Traumatol. 2013;14:143-5

CONCLUSION
Clinical results of Hybrid System in case of Spondylitis TB are

similar to conventional open surgery procedure.

Hybrid System is proved to be more effective in reducing :
Bleeding
Soft tissue damage
Recovery time