Minimally invasive spinal surgery in spinal tuberculosis – A case report series

Spinal tuberculosis is increasing in prevalence in sub Saharan Africa as we find ourselves at the epicentre of immunosuppression secondary to a human immunodeficiency pandemic. Besides the medical management of this condition spinal surgeons must today still decide on the best way to manage the challenges of myelopathy, instability, deformity, and the pre-vertebral and para-vertebral cold abscesses. The large conventional open procedures for debriding and reconstructing spinal tuberculosis, that include a thoracotomy which utilizes a trans-pleural corridor, the lateral extra cavitary approach which involves rib resection and utilizes the extra-pleural corridor, the posterolateral approach which involves a costotransversectomy and thereafter extra pedicular or transpedicular corridors, are increasingly being recognized to carry with them considerable morbidity. To avoid this minimally invasive procedures are increasingly being utilized in the surgical management of this problem. We present a short series of 4 patients who presented to our unit over a 4-year period with spinal tuberculosis that we managed minimally invasively. Our case report series provides four distinct surgical options, amongst many more that are available, and is as such merely a sample of what can be done. We furthermore conducted a PubMed search on the subject and provide an overview of how minimally invasive spinal surgery is being applied to the problem of spinal tuberculosis around the world.