Introduction:
There is a controversy in the recent literature regarding the most appropriate approach to treat spondylitis tuberculosis, whether to choose anterior, posterior, and combined approach as well as one-stage versus two-stage approach. Mesh cage has potential advantages, including inhibition of infection by fusion and reconstruction technique combined with corpectomy. Anterior surgery has advantage as it allows direct access to the diseased vertebral bodies and intervertebral disc.
Case illustration:
We present a case of spondylitis tuberculosis of lower lumbar vertebrae (L5) and L4-L5 intervertebral disc causing paraparese treated with anterior debridement and fusion with expendable mesh cage. Patient presented with weakness of lower limb and back pain, with history of anti-tuberculosis drugs. Patient was diagnosed with paraparesis due to spondylitis Tb of L4-S1 with paravertebral abscess at L4-S1 Frankle D.
Discussion:
The patient was treated with anterior debridement and fusion using expendable mesh cage. Immediate postoperative radiograph showed restoration of vertebral height. This case showed that paraparesis can occur in lower lumbar vertebrae with distinct clinical appearance to that of lower thoracal or upper lumbar spondylitis tuberculosis, and that anterior approach for debridement and fusion using expendable mesh is a logical and direct means of addressing a tuberculous spine lesion, which predominantly affects anterior elements.
Conclusion:
The anterior approach has the advantage of leading the surgeon directly into the lesion and allowing a good visualization. Instrumentation after debridement and bone graft can provide instant stability for the spinal column, which can lead patients to resume activities.