[Lumbar tuberculous spondylodiscitis: a minimally invasive surgical approach]

Tuberculous spondylodiscitis is the most frequent and severe manifestation of extra-pulmonary tuberculosis, accounting for 40 to 50 percent of the cases with osteoarticular involvement. Although antituberculous drugs remain the cornerstone of therapy, surgical treatment still has an important role in the management of some situations. Classical approaches of radical debridement have been gradually replaced by minimally invasive surgical procedures.

The authors describe a case of an 86-year-old male, diagnosed with a L2-L3 tuberculous spondylodiscitis complicated by an anterior epidural abscess, bilateral psoas muscle abscesses and meningoencephalitis. The patient underwent surgery by minimally invasive posterior paramedian approaches with tubular retractors. A L2-L3 discectomy, drainage of the abscesses and L2-L3 percutaneous transpedicular fixation were performed. The procedure and postoperative period were uneventful and the patient had a favourable outcome.

A minimally invasive posterior approach allows adequate access to the spinal canal for neural decompression in cases of spinal infection. Combined with percutaneous internal fixation the procedure prevents the loss of vertebral alignment and facilitates an early mobilization of the patient.