It is an oncologic emergency. This slides contains a brief discussion on mechanism of spinal cord compression , common malignancies presenting with spinal cord compression , approach to a patient with cord compression like features and management this catastrophic situation.
It is an oncologic emergency. This slides contains a brief discussion on mechanism of spinal cord compression , common malignancies presenting with spinal cord compression , approach to a patient with cord compression like features and management this catastrophic situation.
Application of Pstim in Clinical Practice MaxiMedRx
The P-Stim and ANSiStim™ miniaturized device is designed to administer auricular point stimulation treatment over several days. The ear provides numerous points for stimulation within a small area. Stimulation is performed by electrical pulses emitted through strategically positioned needles. The ANSiscope device monitors the pain condition of the patient before, during and after the treatment.
The P-Stim and ANSiStim™ point stimulation therapy is mainly used to treat pain. Use of the device is recommended for pre-operative, intra-operative and post-operative pain therapy as well as for the treatment of chronic pain. DyAnsys is researching the possibilities of using this concept for the treatment of depression, addiction and allergy.
P-Stim and ANSiStim™ therapy allows continuous point stimulation over a period of several days while offering the patient a high degree of comfort and mobility. Use of the P-Stim and ANSiStim™ therapy provides advantages over drug therapy by minimizing possible side-effects caused by pain medications (i.e. opioid). In most cases, the patient continues to lead a normal life without side effects or any loss of quality of life.
Evaluation of Effect of Low Dose Fentanyl, Dexmedetomidine and Clonidine in S...iosrjce
In the present study effect of intrathecal hyperbaric Bupivacaine 0.5% with low doses of Clonidine
or Fentanyl or Dexmedetomidine were compared in elective lower abdominal surgeries. This was a prospective
randomized control trial. 90 patients belonging to ASA 1 &II, aged between 20-50 years were allocated into
three groups. Group-C: Clonidine 30µg, Group-D: Dexmedetomidine 5 µg, Group-F: Fentanyl 25 µg. The
onset of sensory blockade was comparable in all the three groups. The onset of motor blockade was earlier by
about 1.3 mins in Dexmedetomidine group when compared to Clonidine and Fentanyl group. Duration of
sensory blockade was prolonged in Dexmedetomidine group (346mins) when compared to Clonidine (300mins)
and Fentanyl (302mins) group. Time duration of motor blockade was prolonged in Dexmedetomidine group
(269mins) when compared to Clonidine (223mins) and Fentanyl (220mins) group. The haemodynamic
parameters were clinically and statistically insignificant The time of first request for analgesics by the patients
was more in Dexmedetomidine group (250mins) when compared to Clonidine (194mins) and Fentanyl
(189mins) group. The use of intrathecal Dexmedetomidine as an adjuvant to Bupivacaine is an attractive
alternative to Fentanyl or Clonidine for long duration surgical procedures due to its profound intrathecal
anesthetic and analgesic properties combined with minimal side effects.
Expanding the Field of Radiation Therapy for
Malignant Pleural Mesothelioma presented by Kenneth Rosenzweig, MD of Mount Sinai School of Medicine at the Mesothelioma Applied Research Foundation in New York, NY on September 28, 2012. www.curemeso.org
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. The availability of anti tubercular drugs
(1948-1951), a significant milestone, divides
the treatment of tuberculosis into two eras
3. Treatment is best described into
A)Pre chemotherapy era
B)Post chemotherapy era
1)universal surgical extirpation
2)middle path regime
3)Surgery
4. Hippocrates (450 BC) and Galen (131-201
AD) tried to correct kyphotic deformity due to
tuberculosis of spine, by manual pressure,
traction and mechanical appliances, but
failed.
The orthodox conservative treatment
advocated recumbency, immobilization by
means of body cast, plaster beds and
braces.
5. In general, results of these conservative
treatments were disappointing.
Hence, operative procedures were
developed either for the treatment or for the
prevention of paralysis in tuberculosis of the
spine.
6. Laminectomy and Laminotomy:
Chipault in 1896 was the first to use
laminectomy in Potts paraplegia and
later
Fraser performed laminotomy, but,
finally in 1937, abandoned the operation
altogether as the late results were
disappointing.
7. Costo-transversectomy:
Menard in 1894 developed
costotransversectomy, which fell into
general disrepute, because of the high
incidence of sinus formation and of
secondary infection.
8. › Posterior mediastinostomy:
› Obalinski performed the procedure for
the evacuation of tuberculous
paravertebral abscess.
9. › Calve's operation:
› Calve in 1917 devised a method to
aspirate the contents of an abscess
without sinus formation.
10. › Lateral rhachiotomy of Capener:
› Norman Capener in 1933 devised lateral
rhachiotomy, which was a direct attack on the
solid compressing agent anterior to theca,
whereby he excised a part of the lamina and
pedicle from one side to enter the spinal
canal anteriorly and remove the cause of
pressure on the cord.
11. › Posterior decompression with posterior
spinal arthrodesis:
› Albee (1911, 1930) and Hibbs (1912, 1918)
introduced the operation of posterior spinal
fusion. Such operations were carried out 1911
onwards and were developed by many surgeons
to shorten the period of immobilization in the bed
and to provide a permanent internal stability to
the tuberculous spine to avoid recurrence of the
disease and development of paraplegia.
13. • Posterior decompression with posterior spinal
arthrodesis:
› Over the years it became increasingly obvious
that posterior fusion did nothing to the diseased
area where pus, debris and necrotic bone
remained enmeshed and encysted in dense
fibrous tissue, where the organisms remained
alive, sometimes mildly active, in other cases
dormant only to flare up at any chance or
provocation.
14.
15.
16. Fellander , Hodson , Mukopadhya & others
advised for surgical extirpation in all patients
under the cover of anti tubercular drugs as
they thought that these drugs do not
penetrate wall into osseous tubercular
lesions.
But later studies shows that (radioactive
isotopes of streptomycin & isoniazid) these
drugs can penetrate into osseous lesions
including cavities, abscess & even dry
caseous lesion.
17. Usually spinal TB patients are anemic &
have poor nutrition.
While waiting for fitness for surgical
decompression some patients some patients
show neural recovery & ulcer & sinuses
started healing.
This lead to MIDDLE PATH REGIMEN
advocated by TULI.
18. Admission rest in bed
Chemotherapy
X-ray & ESR once in 3 months
MRI/ CT at 6 months interval for 2 years
Gradual mobilization
3-9 weeks- back extension exercise 5-10 min
3-4 times
Spinal brace--- 18 months-2 years
19. Abcesses – aspirate near surface
Instill 1gm Streptomycin +/- INH in sol
Sinus heals 6-12 weeks
Neural complications if responds 3-4 weeks :-
surgery unnecssary
Excisional surgery for posterior spinal disease
Operative debridement for patients –if no arrest
after 3-6 months- spinal arthrodesis
(recommended)
Post op--Spinal brace--- 18 months-2 years
21. India had a National Tuberculosis Programme
(NTP) in place from the '60s, following
epidemiological assessment of the situation
during 1955-1958.
In 1993, the NTP in India was strengthened in
the form of Revised National Tuberculosis
Control Programme (RNTCP).
DOTS is where the patient takes the drugs
under the direct observation (DO) of a health
worker to ensure regularity of consumption of
drugs.
22. Main stay of treatment is prolonged
uninterrupted multi drug anti tubercular
chemotherapy for 12-18mths.
Current guidelines for extra pulmonary TB
involves daily regimen
Intensive phase : 2mths RHZE
Continutation phase: 10-16mths RHE
23. Treatment of tuberculosis of spine can be
discussed in two groups:
1) TB SPINE WITHOUT NEURAL DEFICIT
2) TB SPINE WITH NEURAL DEFICIT
24. The management varies from radical surgery
to ambulant chemotherapy.
Varies multicentre trails conducted with a
follow up of 3 to 10yrs.
25. RECOMMENDATIONS ARE:
No difference in status of tuberculous lesions on
comparison of 2 & 3 antitubercular drugs.
No difference in cure rate on comparision
between bed rest & ambulant chemotherapy.
No difference in results on comparision between
conservative treatment & after radical clearance
of lesion.
No difference on comparision between Hong
Kong method of anterior decompression & fusion
with anterior spinal instrumentation.
26. As the results of ambulant chemotherapy are
comparable so all TB spine patients without
neural complications are treated non
operatively.
These cases operated only in following
conditions:
Doubtful lesions.
Pan vertebral lesions
TB spine with severe kyphosis.
Failure of conservative treatment.
27. A. Braces
B. Vitamin D supplementation
C. Protein supplementation.
28. MONITORING TREATMENT RESPONSE:
All cases of spinal TB should be monitored every
2mths.
A) CLINICAL
B) HEMATOLOGICAL
C) RADIOLOGICAL:
Appearance of remineralization of VB
Sharpening of disc margin.
D)IMAGING: MRI @ 9,12, & 18mths.
E)AMBULATORY CHEMOTHERAPY patients
29. FAILURE OF CONSERVATIVE
TREATMENT
Drug resistance to anti tubercular drugs has
been reported in 1948.
Drug resistance is one of the cause failure of
treatment.
It could be due to :
Inappropriate treatment
Exposure to pulm. MDR TB case
Infection in immunocompramised pts.
30. When a pt develops resistance to one drug -
MONORESISTANCE
Resistance to two or more drugs –
POLYRESISTANCE
Resistance to RIFAMPICIN & ISONAZID –
MULTI DRUG RESISTANCE(MDR-TB)
Resistance to RIFAMPICIN & ISONAZID &
ALSO injectable aminoglycosides & a
fluoroquinolone –EXTENSIVE DRUG
RESISTANCE
31. CLINICAL
HAEMATOLOGICAL
MRI
NEW LESION
NON HEALING ULCER
NEW COLD ABSCESS/LYMPH NODE
WOUND DEHISCENCE
In these cases lesion should be debrided &
sent for histopathology , AFB,Gene Xpert &
Line Probe Assay , C/S.
32.
33.
34.
35.
36.
37. Management of multi drug resistant -
tuberculosis
Should be referred to specialized units with
facilities for quality-controlled drug
susceptibility testing (DST) and experience
in handling such cases.
Drug selection must rely on prior treatment
history, results of susceptibility testing and
an evaluation of the patient's adherence.
38.
39.
40.
41.
42. Neurological complications is the most
dreaded complications & crippling
complication of spinal TB.
Overall incidence is between 10%-30%.
Paraplegia results from interference with
function of cord.
43. Parplegia due to TB spine classified into 2
main groups (Griffith, Seddon & Roaf 1956)
in pre antibiotic era.
GROUP A (EARLY ONSET
PARAPLEGIA)
GROUP B (LATE ONSET
PARAPLEGIA)
44.
45.
46.
47.
48.
49.
50. The three definite methodologies have
evolved about treatment of TB spine with
neurological deficit:
A)Absolute non-operative
B)Universal surgical extirpation
C)Middle path regimen
51. A)Absolute non-operative :
Dabsen (1951) reported that 48% of
paraplegia improved neurologically by
traditional conservative care in pre antibiotic
era.
MRC trails (1978) considering early disease
(involving with little kyphosis &
paraparesis)have concludes that pott’s
paraplegia with active disease can be
managed by conservative methods on ATT
only.
52. B)Universal surgical extirpation:
In all tuberculous paraplegia cases surgery
performed by anterior decompression with or
without fusion.
Reported neurological recovery vary from
37-94%.
53. Advantages :
Diagnosis was established beyond doubt.
Quality & speed of neural recovery was
good.(<2mths vs conservative 2-6mths).
Decompression removes fibrous barrier to
drugs.
54. C)TULI has advocated based on his
experience in treating TB spine with
paraplegia:
A judicious combination of conservative
therapy & operative decompression when
needed should form a comprehensive
integrated course of treatment for TB spine
with neurological complications.
55. Indications of surgery are adapted from Griffith,
Seddon, Tuli & Jain et al.
TREATMENT FACTORS
1.Worsening of neurological complications
2.No signs of improvement
3.Worsening of neural deficit.
56. CLINICAL FACTORS:
1.Paraplegia with rapid onset
2.Severe paraplegia
3.Spinal tumor syndrome
4.Paraplegia with neural arch affection.
5.Recurrent paraplegia
6.Paraplegia with spasticity
7.Patients with massive pre vertebral
abscess.
57. IMAGING FACTORS:
1.Painful paraplegia
2.Parraplegia with onset in old age.
58. It includes full exposure of the front of the
duramater at the apex of kyphosis.
59. DEBRIDEMENT SURGERY:
Removal of all pus, caseous tissue, sequestra
but without removal of unaffected or viable bone
except to provide adequate access to the focus &
to decompress spinal cord.
RADICAL SURGERY:
By Hodgson & Stock.
Radical excision of tuberculous focus with repair
of resultant gap with autogenous bone graft.
60. The cancellous bone exposed.
Upadhyay(1994) reported that neurological
recovery in both radical & debridement
surgery was equally good & no patient had
pain.
64. Tracheostomy before
operation
Position: Place head in
hyperextension & pack
hypo pharynx.
Incision: Midline posterior
pharyngeal wall from tip of
anterior tubercle of atlas,
which is palpable.
Strip subperiosteally
Anterior archof atlas body
of axis & atlantoaxial joints
exposed.
Anterior decompression &
fusion can performed.
65. Incision: Collar incision of neck between hyoid
bone & thyroid cartilage.
Divide sternohyoid & thyrohyoid m/s.
Avoid injuring ILN & SL vessels
66. Expose posterior pharyngeal wall & elevate
superiosteally.
Bodies of C2, C3, C4 are exposed.
It allows Extramucosal exposure, anterior
debridement & fusion of upper cervical spine.
Less risk of secondary infection.
67. POSITION: Supine with head rotated
to side opposite & neck in extension.
Longitudinal incision along medial
border of SCM.
Open space between SCM & IJV.
Transverse process identified with
finger.
Identify sympathetic chain lies on
longus colli.
Retract it laterally & expose vertebral
bodies between two longus colli.
68. In severe kyphotic deformity of cervical spine
with long segment disease .
It may need two stage surgery where
posterior instrumentation is followed by
anterior decompression & bone grafting.
Three approaches are used for this are:
LOW ANTERIOR CERVICAL APPROACH
HIGH TRAANSTHORACIC APPROACH
TRANSSTERNAL APPROACH
69. A transverse incision taken one finger
breadth above clavicle.
Extend across midline and take care
dissecting around carotid sheath.
Then follow conventional anterior approach.
This approach limited exposure upto T1.
70. It allows exposure from C6 to T4.
A kyphotic deformity of thoracic spine tends to force
cervical spine into chest.
This approach is a logical choice.
Periscapular incision.
Remove 2nd & 3rd rib helps sufficient working place if a
kyphotic deformity present in a child.
71. 7.5-cm incision along
the posterior border of
the SCM mid-upper 3rd
.
Protect SAN.
Using blunt dissection
palpate the abscess
Drain abscess
73. ALEXANDER developed an operation with
DOTT EDINBURGH
He removed posterior ends of 3 or more ribs
& their corresponding transverse process, &
pedicles adjacent VB.
Then opened paravertebral abscess &
decompression achieved at respective level.
CAPNER described LATERAL RACHOTOMY
main purpose was to deal directly with cause
of cord compression.
74. Described by MENARD in 1894
This approach helps in evacuating
abscess in dorsal spine .
Midline incision
Elevate soft tissue & periosteum
from spinous process & laminae
over abscess.
Resect transverse process at its
base.
Resect the contiguous rib of 5cm.
Open abscess by blunt dissection.
Wash & close in layers.
75. Described by SEDDON.
Incision over midline
proximal to apex of kyphosis.
Divide erector spinae m/s
transversely apposite to
apex of deformity.
76. Expose about 8.3cm of rib & Lateral 3rd laminae.
Transect rib of about 6.8cm lateral to costotransversre joint.
Expose abscess with finger , reaching vertebralbodies
small cavities, &
dislodging necrotic
material.
Remove tuberculous
material.
Fill cavity with
streptomycin powder.
close wound without drain.
77. Patient in lateral
decubitus position with
bean bag .
Incision over
correcsponding involved
vertebra & expose
subperiosteally.
Disarticulate rib from
transverse process &
VB.
Hodgson & stock described propagated for anterior
clearance of lesion & Reconstruction by bone grafting.
78. Incise parietal pleura &
reflect it off the spine.
Pleural adhesions cleared
gradually.
It allows adequate exposure
for debridement & grafting.
80. JAIN ET AL. (2004) modified the incision to a
T- INCISION.
A midline incision taken centering apex of
kyphosis on left side.
Two triangular fasciocutaneous flaps were
held with stay sutures.
Anterolateral decompression done.
81.
82. Patient is stable in lateral position.
Anterior & posterior column can be exposed
simultaneously.
Anterior corpectomy & bone grafting with
simultaneous posterior Hartshill fixation can be
done.
It avoids 2nd stage procedure.
Thoracolumbar lesions at D12 Vb can be
exposed by removing 12th rib & ICN.
Avoids pulmonary sequelae as plane of surgery
if extrapleural & retroperitoneal.
83. Patient in right lateral
decubitus position.
Curvilinear incision taken.
Resection of 10th rib
exposure T10 to L2.
Avoid entering abdominal cavity.
As transversalis fascia & peritoneum do not diverge.
So dissect with caution.
84. Reflect diaphragm from lower ribs & crus from side of spine.
Incise prevertebral fascia.
Identify segmental arteries & veins over VB.
Expose bone.
85. It is popularized in recent past.
Spine exposed by midline posterior approach.
Disadvantage of this approach in TB spine is that
it necessitates resection of lamina(post-complex
)which is healthy verterbra in anterior disease
leads spine unstable.
Spine is temporarily stabilized by pedicle screws.
86. Anterior decompression also can be done by
removing 2-3 ribs on both sides at affected
level.
Anterior lesion can be approached.
Advantage of this approach is that
decompression & deformity can be
performed in single stage.
Good approach when 2-3 VB are diseased.
Less morbid & hospital stay.
87. Approached through Retroperitoneal
approach (similar to sympathectomy
approach).
88. Approach through Hypogastric para median
trans peritoneal approach.
Lumbar & Lumbosacral region approached
through retroperitoneal sympathectomy
approach.
89. Patient placed in lateral
position
Depending on level of
involvement oblique incision
taken between 12th rib & iliac
crest.
Abdominal m/s cut in line. I,e sc tissue,fascia & m/s of
external oblique, internal oblique.
Retroperitoneal space reached.
90. Lumbar vertebrae are palpated & lumbar vessels are
ligated over affected level.
Psoas m/s is elevated from anterior border.
Pedicles & intervertebral foramina identified.
Anterior decompression & instrumentation can be
performed now.
If posterior instrumentation needed separate approach
needed
91. PARAVERTEBRAL ABSCESS
A longitudinal incision lateral to
midline taken.
Divide deeper layers
Usually abscess encounter
immediately if not puncture TL fascia
& deeper structures.
After thorough evacuation of abscess
Close incision in layers.
92. PSOAS ABSCESS
Abscess are extra peritoneal
It follow course of muscle.
Drainage can be done through
Petit triangle.
93. Petit triangle is formed by lateral
Margin of latismus dorsi & medial
border of external oblique m/s
Base by iliac crest.
Floor is the internal oblique m/s.
Incision made parallel to posterior
crest of ilium.
Expose petit triangle.
Bluntly dissect in floor m/s directly
into abscess.
Wash & close incision in layers.
94. Pan vertebral disease: Instrumentation should
be done to prevent subluxation /dislocation of
spine.
Long segment disease: Disease of 4 or more
vertebral bodies .
In lumbar & cervical spine:As there are no
costotransverse & costovertebral articulation as
like in dorsal spine.
When kyphosis correction surgery is completed
In junctional area such as CD spine & DL spine.
95.
96.
97.
98.
99.
100.
101.
102.
103.
104. Main complication of TB spine is KYPHOTIC
DEFORMITY.
Pathology:
TB lesion start as paradiscal inflammation
Vertebral end plates becomes weak & IVD
herniating into VB.
Severity depends on number of VB
affected,loss of VB height & segment of
spine.
105.
106.
107. By the time kyphosis appears in spine,
disease is already about 3 to 4 mths of
pathogenesis of disease.
108. multiple vertebral involvement, active growth
and situation of the lesion in the thoracic
spine were responsible for the excessive
increase in kyphosis.
Increase in kyphosis was observed in 67% of
the thoracolumbar region, 55% of the
thoracic and 33% of the lumbar lesions.
109. Rajasekaran and Shanmugasundaram,
1987, calculated that future angle (Y) of
kyphotic deformity in tuberculosis of the
spine could be reasonably predicted by
using a formula Y = a + bx, where x is the
initial loss of vertebral bodies (height in cm)
and a and b are constants 5.5 and 30.5,
respectively.
110. In young children having thoracic lesions
with involvement of three or more vertebrae,
recumbency in the prone position in the early
active stage and operative debridement and
bone grafting posteriorly for panvertebral
stabilization may minimize the development
of progressive kyphotic deformity.
111. The only operative procedure that has been
claimed to prevent increase of kyphotic
deformity is the radical excision and bone
grafting performed in Hong Kong by pioneers
of the radical operation themselves.
112. severe deformity in the presence of active
disease should be an absolute indication for
decompression, correction and stabilization,
as late reconstruction of tuberculous
kyphosis was a difficult and dangerous
procedure.
113. Rajasekaran (2002) suggested stabilization
of the spine posteriorly followed by anterior
debridement and bone grafting in the active
stage of the disease.
In the healed stage with rigid deformity, he
suggested anterior debridement first to be
followed by posterior instrumentation and
anterior fusion.
114. VATS provides a significant advantage of
minimum blood loss, less tissue damage,
less pain in the postop period, short hospital
stay, better illumination and better
magnification.
difficult to perform endoscopy in TB as there
is poor distinction of tissues, adhesions and
bleeding granulation tissue.
115. Pedicle screw fixation for kyphosis correction
in healed TB is the most suitable implant.
Hartshill sublaminar wiring stabilisation in
active disease is a suitable implant to
stabilise the spine, ensuring purchase
against the healthy posterior complex of the
vertebral body to save a segment.
116. To control mechanical instability or pain due
to this instability and not due to grumbling
disease,
For arresting the progress of kyphosis and
During correction of spinal deformity in a
panvertebral operation.
117. Anterior radical debridement and strut
grafting with instrumentation is indicated in
all patients – especially those with thoracic
TB and those already treated – but is
dangerous in patients with lumbosacral
spinal TB due to the complicated anatomy.
118. Is indicated in patients with thoracic or
thoracolumbar spinal TB whose lesion are
located in the posterior part of the vertebral
body or who are not fit for thoracotomy or
elderly
119. In patients with lower lumbar spinal TB
whose foci are located in the posterior part of
the vertebral body, with compressed nerve
roots and spinal cord, resulting in spinal
stenosis, but without obvious caseous
abscess or sequestra in the anterior part of
the vertebral body.
120. Severe destruction by the lesion, resulting in
the impossibility of anterior instrumentation,
or in patients with severe lower lumbar
kyphosis that requires lordosis correction
and restoration
In whom Initial anterior instrumentation
failed.