Clinical Evaluation of Spinal Tuberculosis Treated with Hemilaminectomy

OBJECTIVE: The variable operative methods are underwent as a treatment of tuberculous spondylitis. We propose hemilaminectomy and debridement as a one of operative method at a certain circumstance. METHODS: From July 1998 to June 2002, 13 consecutive patients with spinal tuberculosis were treated surgically in our institution. Among them, the authors analysed 7 patients in whom posterior approach were performed. The lumbar spine was involved in 6 patients, the thoracic in 1. The hemilaminectomy with debridement was done in all cases. The changes in the Kyphotic angle and the height of involved vertebras retrospectively measured from lateral spinal radiographs obtained preoperatively and postoperatively. Mean follow up periods were 16 months. RESULTS: Clinical symptoms and signs were improved in all cases. One patient (14%) was needed anterior fusion because of aggravation of lesion. Another one needed reoperation because of relapse of epidural abscess. The arithmethical average of kyphotic angle was worsened about 2 degrees and that of height loss was lesser than 5% postoperatively. CONCLUSION: The hemilaminectomy with debridement for spinal spondylitis can be a first therapeutic modality in a mild neurologic deficit and minor lesions with extended epidural abscess and granulation tissue to the adjacent vertebras in radiologic finding. Especially if epidural abscess and granulation tissue involve the multiple vertebras, we recommend this operative method.

Migration of Intracranial Subdural Hematoma to Spinal Canal

The spinal subdural hematoma (SSDH) is a rare disease entity, but may have disastrous consequences. A 48-year-old man who underwent a craniotomy for a removal of acute traumatic subdural hematoma was referred to our hospital because of remnant hematoma and sustained headache. His mental state was clear and the score of Glasgow Coma Scale was 15. On 11days after admission, he complained of lumbago and radicular pain in the lower extremities. Lumbar magnetic resonance image (MRI) revealed subacute lumbosacral subdural hamatoma. A lumbar puncture was performed and about 20cc amount of dark liquefied hematoma was drained. His symptoms were improved and the SSDH was disappeared on follow-up MRI. This SSDH is assumed to be formed by the migratory movement of intracranial subdural hematoma under the influence of gravity, and spinal puncture is another preferable procedure in such cases of liquefied spinal hematoma.