lpsep approach - case by dr. rajiv jha
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LPSEP Approach - Case by Dr. Rajiv JhaTRANSCRIPT
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Dr Rajiv Jha , MS
Resident M Ch Neurosurgery
National Neurosurgical Referral Center
National Academy Of Medical Sciences
Bir Hospital
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28 years,Male
Trishuli ,Nuwakot
Farmer
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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
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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
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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 -
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Pulmonary tuberculosis D1/D2 Pott’s Spine with paraparesis
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Lateral Parascapular Extrapleural Corpectomy Findings : distructed D1/D2 vertebral body with
pus collection about 10 ml
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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
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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
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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
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1.Anterior transcervical approachessupraclavicular,transclavicular/transmanubrial,transsternal
2.Anterolateral transthoracic approach
3.Posterolateral approachescostotransversectomy,lateral extracavitary,lateral
parascapular extrapleural and
4.Posterior approachesLaminectomy,transpedicular
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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
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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