Sumit Arora1, Ramesh Kumar, Sumit Batra, Rohit Nath. 1. Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, G.B. Pant Hospital, New Delhi, India. mamc_309@yahoo.co.in
Abstract
STUDY DESIGN: We describe 3 patients with lumbosacral tuberculosis with epidural and presacral abscess who presented to us with acute cauda equina syndrome. A novel technique of draining the abscess and its results are described. OBJECTIVE: To describe a novel technique of draining the presacral abscess and to evaluate the results in the patients treated with this technique. SUMMARY OF BACKGROUND DATA: Osteoarticular tuberculosis, especially spinal tuberculosis, is a major health problem in developing regions of world. The presacral region is one of the uncommon yet difficult regions for the drainage of abscess. Acute cauda equina syndrome because of lumbosacral tuberculosis is a rare entity. We describe a series of 3 such cases of tubercular etiology who presented to us with cauda equina syndrome. RESULTS: All of them had complete neurologic recovery within 3 weeks of performing transpedicular drainage of presacral abscess and cauda equina nerve root decompression by laminotomy. All the patients were asymptomatic with normal blood parameters and healed radiologic status at 2 years follow-up. CONCLUSIONS: The transpedicular approach to the presacral region is a safer option compared with other approaches to reach this region. It simultaneously allows decompression of cauda equina nerve roots by laminotomy without changing the position of the patient in the theater. The key to success with this approach is early diagnosis and early treatment.
STUDY DESIGN: We describe 3 patients with lumbosacral tuberculosis with epidural and presacral abscess who presented to us with acute cauda equina syndrome. A novel technique of draining the abscess and its results are described. OBJECTIVE: To describe a novel technique of draining the presacral abscess and to evaluate the results in the patients treated with this technique. SUMMARY OF BACKGROUND DATA: Osteoarticular tuberculosis, especially spinal tuberculosis, is a major health problem in developing regions of world. The presacral region is one of the uncommon yet difficult regions for the drainage of abscess. Acute cauda equina syndrome because of lumbosacral tuberculosis is a rare entity. We describe a series of 3 such cases of tubercular etiology who presented to us with cauda equina syndrome. RESULTS: All of them had complete neurologic recovery within 3 weeks of performing transpedicular drainage of presacral abscess and cauda equina nerve root decompression by laminotomy. All the patients were asymptomatic with normal blood parameters and healed radiologic status at 2 years follow-up. CONCLUSIONS: The transpedicular approach to the presacral region is a safer option compared with other approaches to reach this region. It simultaneously allows decompression of cauda equina nerve roots by laminotomy without changing the position of the patient in the theater. The key to success with this approach is early diagnosis and early treatment.