Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study.
The risk of persistence and recurrence of infection in posterior spinal instrumentation surgery for spinal tuberculosis was studied clinically and microbiologically. Eleven patients with thoracic, thoracolumbar, and lumbar spinal tuberculosis treated by debridement, anterior fusion, and combined posterior instrumentation surgery were analyzed. Seven patients had tuberculosis in both anterior and posterior spinal elements. There were no cases of persistence or recurrence of infection after surgery, and instrumentation provided immediate stability and protected against development of kyphotic deformity. The adherence properties of Mycobacterium tuberculosis to stainless steel (SUS 316) was evaluated experimentally. The results showed that posterior instrumentation surgery was not a hazard to spinal tuberculosis infection when combined with radical debridement and intensive anti-tuberculosis chemotherapy.
We performed a single stage video-assisted thoracoscopic surgery for bilateral spontaneous pneumothorax in the supine position with both arms abduced and the back slightly elevated using a pillow. While intercostal spaces were not open enough to insert a trocar, this procedure, not requiring the trouble of placing patients in the lateral decubitus position, is beneficial for the single treatment of bilateral thoracic discase.