Arthroscopic Anterior Capsular Release for Idiopathic Frozen Shoulder
PASMISS Deded
1. ONE YEAR FOLLOW UP
ON HYBRID SYSTEM IN
SPINAL TUBERCULOSIS
SURGERY: A CASE
REPORT
Department Orthopaedic and Traumatology
Faculty of Medicine, Universitas Indonesia
Cipto Mangunkusumo Hospital
2. INTRODUCTION
▪ Spondylitis TB leads to the instability of the spine due to damage to
the corpus and makes neurologic deficit.1,2
▪ New Procedures conventional technique and minimally invansive
technique (Hybrid System) allows minimal incisions only at the level of
pathologic vertebrae3,4
▪ Aim of study to asses outcomes of minimally invansive technique in
the surgical treatment of spondylitis TB
1. Kandwal P, Garg B, Upendra B, Jayaswal A. Outcome of minimally invansive surgery in the management of tuberculous
spondylitis. Indian J Orthop. 2012;46:159-64.
2. Rigotti S, et al. Minimally invansive posterior stabilization for treating spinal tuberculosis. J Orthopaed Traumatol. 2013;14:143-5.
3. Hanaoka N, KawasakiY, Sakai T, Nakamura T, Nanamori K, Nakamura E, Uchida K, Yamada H. Percutaneous drainage and
continuous irrigationin patients with severe pyogenic spondylitis, abscess formation, and marked bonedestruction. J
NeurosurgSpine. 2006;4: 374-9.
4. Ito M, Sudo H, Abumi K, Kotani Y, Takahata M, FujitaM, Minami A. Minimally invasivesurgical treatment for tuberculous
spondylodiscitis. Minim Invasive Neurosurg.2009; 52: 250–253.
3. METHODS
▪ A female, 26 yo, with diagnosis spondylitis TB at the level Th12-L1 and L4-
L5
▪ Indication of surgery were back pain + neurologic deficit and progressive
paraspinal abscess
▪ Treated by posterior spine stabilization with mini open posterolateral
debridement + fusion + percutaneous abscess drainage
▪ Evaluated : blood loss, duration of surgery, length of stay, Visual Analogue
Scale (VAS) scores, fusion status, neurological state and Oswetry Disability
Index (ODI)
4. CASE ILLUSTRATION
▪ Chief complain : back pain radiating to the right hip since 6 months ago
▪ History of tuberculosis, currently on anti tuberculosis regimens at the 4th
months
5. PHYSICAL EXAMINATION
▪ Tenderness on Th12-L1(VAS 7-8)
▪ No gibbus or sinus
▪ Hypesthesia at right L1 dermatome
▪ Abscess paraspinal
▪ No motoric disturbance
6. X RAY
- Erosion on Th12-L1
spinal body
- Discal narrowing
- Lytic lesion,inferior-
anterior of L4
- Fusiformic shadow atright
paravertebralTh7-S2
9. ABSCESS DRAINAGE
▪ Aspiration using 10cc syringe
for validation
▪ 1,5 cm incision was made
▪ Around 700cc of casseous pus
was suctioned from the
abscess cavity
▪ Drain was left
10. POST OPERATIVE
▪ Drain was released at the
3rd
day (total drain
production was 100cc)
▪ At the 5th
day patient was
discharged. At the day,
VAS was 3-4 (from 7-8), and
patient can walk normally
▪ Anti-tuberculosis regimen
was continued 8 months
after the surgery (total was
12 months of regimen)
13. DISCUSSION
▪ Minimal invasive surgery has been providing an alternative that may
decrease the morbidity caused by open surgeries1,2
▪ Intraoperative blood loss was 150cc. This is less than blood loss from
posterior stabilization, which range from 200-800cc. Shorter length stay
(10 days to 5 days)`1
▪ On follow up, good fusion was achieved. VAS and ODI score were
improved in 6 moths and better in 12 months→ clinically patient became
better
▪ This case report had same result as Rigotti et al: in overall, minimally
invasive spine surgery produced a good outcome for spondylitis tb cases2
1. Kandwal P, Garg B, Upendra B, Jayaswal A. Outcome of minimally invansive surgery in the
management of tuberculous spondylitis. Indian J Orthop. 2012;46:159-64.
2. Rigotti S, et al. Minimally invansive posterior stabilization for treating spinal tuberculosis. J
OrthopaedTraumatol. 2013;14:143-5
14. CONCLUSION
▪ Clinical results of Hybrid System in case of Spondylitis TB are
similar to conventional open surgery procedure.
▪ Hybrid System is proved to be more effective in reducing :
▪ Bleeding
▪ Soft tissue damage
▪ Recovery time
