Lumbosacral spinal tuberculosis

Lumbar and sacral spinal tuberculosis refers to the tuberculosis of the vertebral body from the third lumbar vertebra to the third vertebra. The anterior approach is commonly used in clinical practice, and it can be divided into two types: transperitoneal and transperitoneal. Transabdominal lesion removal is a mid-abdominal incision, incision of the peritoneum, pushing open the intestine, and incision of the posterior peritoneum to reveal and clear the lesion. Because the incision is centered, although the exposure is more direct, it is inconvenient to handle the psoas abscess on both sides, or a retroperitoneal incision is required to clear it. Due to the operation through the abdominal cavity, the disturbance of the abdominal cavity is greater, and the pelvic stimulation is also heavier. Postoperative abdominal distension, urinary retention, etc. are prone to occur, and may even cause intestinal adhesions or intra-abdominal tuberculosis infection. Extraperitoneal lesion removal is performed through a lateral abdominal incision to push the peritoneum apart to reveal and clear the lesion behind the peritoneum. The disadvantage is that one incision cannot remove the lesions on both sides, and another incision needs to be performed on the opposite side for surgery or fractional surgery. In addition, the incision is sideways, and the treatment of vertebral lesions is not straightforward. However, if the operation technique can be improved, the lesions can still be removed more thoroughly, and the disadvantages of the transabdominal route can be avoided, which is safer. Therefore, the clinical use of extraperitoneal lesion removal. Only patients who have failed multiple transperitoneal approaches and are estimated to have severe adhesions, who are unable to reach the lesion from outside the peritoneum, should undergo transabdominal lesion removal.