Spinal tuberculosis usually affects the thoracolumbar spine, with only 2-3% involving the lumbosacral region. Lumbosacral tuberculosis can lead to the formation of a presacral abscess. For drainage of the spinal abscess, the presacral region is one of the problematic regions to perform. Minimally invasive surgery (MIS) is an essential clinical technique for the debridement of the spinal abscess in order to decrease the morbidity acquired by the patient. We presented a case of lumbosacral tuberculosis treated with abscess evacuation using the MIS technique.
A 28-year-old male came with the chief complaint of back pain and a lump in the right groin area for four months before admission. Physical examination showed a lump and bilateral positive straight leg raising. Preoperative Oswestry Disability Index (ODI) and the Japanese Orthopaedic Association (JOA) scores showed moderate disability and normal function, respectively. Radiologic examinations showed signs of lumbosacral tuberculosis. The patient underwent abscess evacuation using MIS of presacral approach as described for axial lumbar interbody fusion (AxiaLIF), and improvement in ODI score was noted.
A presacral approach, as what we performed, is a simple approach that can reach the location of the abscess by using fluoroscopic guidance. Abscess evacuation was confirmed by the presence of clear fluid, which indicated that the caseous material had been removed thoroughly, and also, as the clear fluid was no longer noticed.
The success of this approach depends on the time of surgery. When surgery is delayed, the granulation tissue has been formed, making minimally invasive techniques for surgical evacuation much more difficult.
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