COMPLICATED LUMBAR TUBERCULOUS SPONDYLODISCITIS IN DISSEMINATED TUBERCULOSIS, TREATED USING A NON-CONVENTIONAL ANTERIOR SUPPORT SYSTEM FOR HYDROSTATIC DISTRACTION: A CASE REPORT

TRATAMENTO DE ESPONDILODISCITE LOMBAR COMPLICADA EM TUBERCULOSE DISSEMINADA COM SISTEMA HIDROSTÁTICO DE DISTRAÇÃO LOMBAR: RELATO DE CASO

ABSTRACT

Objective:

To describe a case of disseminated tuberculosis affecting the lumbar spine that was treated using a non-conventional anterior support system.

Background:

Tuberculous spondylodiscitis is the most common and most severe form of extrapulmonary tuberculosis. Although antibiotic therapy is the most frequently used treatment, surgery is necessary in cases of neurological deficit, spinal instability, significant deformity, severe sepsis, paravertebral and epidural abscesses or in cases wherein clinical treatment has failed. A surgical procedure is also indicated when a biopsy is required. With the development of new methods for reconstruction and fixation of the spine, complete debridement of the tuberculous foci has become an increasingly common approach, but there is a lack consensus on the best technique.

Methods and results:

The patient suffered from disseminated tuberculosis affecting the lumbar region of the spine, with an abscess in the psoas muscle. He underwent extensive debridement via both anterior and posterior approaches, using a non-conventional anterior support system that promotes hydrostatic distraction.

Conclusions:

Treatment using the hydrostatic distraction system was able to reestablish both the stability and anatomy of the lumbar curve. Level of evidence IV, Case report.

Keywords:
Spinal tuberculosis; Osteoarticular tuberculosis; Debridement; Surgical procedures