Dr Rajiv Jha , MS

Resident M Ch Neurosurgery

National Neurosurgical Referral Center

National Academy Of Medical Sciences

Bir Hospital

28 years,Male

Trishuli ,Nuwakot

Farmer

A case referred from medical unit ,BH Unable to move lower limbs -12 days Numbness, tingling sensation and decrease

sensation below umbilicus – 45 days Pain Rt scapular area – 1 month Bowel/ Bladder habits – Normal No trauma /Fever A diagnosed case of PTB ,ATT – since Jestha Non smoker / alcoholic

Vitals : Ps -76 BP- 110/70 T –Normal Spine – Normal RUL LUL RLL LLL Power 5/5 5/5 1/5 1/5 Sensation below D4 dermatome Tone increased Bulk normal reflexes exaggereted

Haemogram ESR22 Biochemistry LFT CXR S. Calcium – 8.4(8-11) HIV, HBsAg, anti HCV – negative beta HCG – negative X-ray Thoracolumber spine MRI Thoracic spine -

Pulmonary tuberculosis D1/D2 Pott’s Spine with paraparesis

Lateral Parascapular Extrapleural Corpectomy Findings : distructed D1/D2 vertebral body with

pus collection about 10 ml

POST OP PRE OP

Vitals NormalSpine – Normal RUL LUL RLL LLLPower 5/5 5/5 4/5 4/5Sensation intactTone normal

Bulk normalReflexes normal

Vitals : Ps -76 BP- 110/70 T –Normal

Spine – Normal RUL LUL RLL LLLPower 5/5 5/5 1/5 1/5Sensation below D4

dermatomeTone increased

Bulk normalreflexes exaggereted

In 1779- Percivall Pott Most lethal infectious disease - 3 million deaths/year Bone and soft-tissue tuberculosis accounts for approximately 10%

of extrapulmonary tuberculosis cases and between 1% and 2% of total cases.

Tuberculous spondylitis is the most common manifestation of musculoskeletal tuberculosis, accounting for approximately 40-50% of cases.

Cervical spine – 10%,thoracic spine -50% and lumbar spine – 40%

Spread – haematogenous/local extension/Batson’s venous plexus the frequency of Pott Disease is related to socioeconomic factors

and historical exposure to the infection. Pott disease does not have a sexual predilection Pott disease occurs primarily in adults

Metastatic tumors Primary tumors of bone Primary lympohma Intradural, extramedullary tumors Intradural, intramedullary tumors Bacterial infections Tuberculous infections – 5% of the spine* Vascular malformations Pathologic fracture (primary metabolic disease of bone) Connective tissue and skeletal disorders Traumatic vertebral fractures Disc herinations

*Neurology India 50 ,March 2002

1.Anterior transcervical approachessupraclavicular,transclavicular/transmanubrial,transsternal

2.Anterolateral transthoracic approach

3.Posterolateral approachescostotransversectomy,lateral extracavitary,lateral

parascapular extrapleural and

4.Posterior approachesLaminectomy,transpedicular

Transmanubrial and transclavicular Pathology extends from C6 or C7 to T1 or T2 but not

below T2 Anterolateral thoracotomy Pathology limited to T3 and /or T4 Lateral parascapular extrapleural Pathology extends from C7-T4

The advantage of this approach is that decompression of neural tissue is performed under direct visualization at all times,with minimal manipulation of the thecal sac and in addition,posterior stablization can also be performed simultaneously through the same incision