Posterolateral Thoracotomy Approach to Tuberculous Spondylitis of the Upper Thoracic Vertebrae

Bone and joint involement develops in approximately 10 percent of patients with tuberculosis and half of these affected patients have tuterculosis of the spine. The goals of management are to eradicate the infection and to prevent or treat neurologic deficits and spinal deformity. An operation may be performed to drain abscess, to debride sequestered bone and disc, to decompress the spinal cord, or to stabilize the spine for the prevention of correction of deformity. But there are difficulties in approaching the upper thoracic spine(T1-T3). These vertebral bodies can be visualize through a standard thoracotomy. Access is greatly restricted, however, by the scapula and the remaining rabs, making a vertebrectomy and spinal cord decompression very difficult. Reconstruction of the vertebral defect and instrumentation to give spinal stability are equally difficult. We describe a surgical approach to the upper thoracic spine which allow an adequate exposure of the vertebral bodies from T1 to T3. The posterolateral thoracotomy approach seems to be a safe and useful method for the upper thoracic lesion, allows adequate exposure exposure and easy reconstruction.

A Case of Syringomyelia in Cervical and Thoracic Spinal Cord(C2~T10) Associated with Chiari Malformation

We have recently managed a case of syringomyelia associated with Chiari I Type malformation. The syrinx was found at C2 level to T10 level. And the patient complained left forearm pain and paresthesia in left shoulder, arm with segmental dissociated sensory loss. The cranio-vertebral decompression(suboccipital craniectomy, cervical laminectomy) and the shunting procedures were performed. Postoperative course was not uneven, the clinical and neurological improvement was observed. M.R.I. permitted rapid, exact diagnosis including localization of syrinx and information of associated anomaly.

A Case of Third Ventricular Cysticercosis

Cerebral cysticercosis is relatively common disease in Korea. But cysts in the ventricular system are rare form. In the ventricular system, they occur most frequently in the 4th ventricle, more rarely in the lateral and 3rd ventricle. We have recently experienced a case of cerebral cysticercosis which involved the 3rd ventricle. A sixty-year old man was admitted because of generalized seizure attack followed by drowsy mentation. On admission, there were no specific localizing and lateralizing neurological abnormalities except bilateral, mild degree optic papilledema. Brain CT scan after intraventricular metrizamide administration disclose a cystic mass in the third ventricle. And the serum ELISA test was positive(patient's titer : 0.31, normal : below 0.18). Anterior transcallosal approach was performed and cystic mass was removed from the third ventricle. Pathological diagnosis of the specimen was cysticercosis. Following surgery, the patient's symptom cleared up and papilledema disappeared gradually.

Anterior Interbody Fusion Using Kaneda Device in Unstable Thoracolumbar Spinal Lesions

Recently anterior spinal device in the treatment of the unstable thoraco-lumbar spine has been used. We have experienced 11 patients of the unstable thoraco-lumbar spine, which were composed of 8 patients with burst fracture and 3 patients with tuberculous spondylitis. The 11 patients with neurological deficit were treated with an one stage anterior operation consisting of anterior decompression through vertebrectomy, realignment with Kanedae device. No patient showed neurologic deterioration after surgery. The anterior spinal instrumentation with Kaneda device afford enough stability to enable early ambulation with good alignment and solid fusion.