Bệnh đang hoạt động, intraoperative lực kéo thường là kết quả sửa chữa một phần của biến dạng. Khi biến dạng vượt quá 40 ° nó có thể được khôn ngoan để cụ đầu tiên phía sau, đạt được hiệu chỉnh biến dạng và sau đó debride và cầu chì phía trước. | 44 Tropical Neurology Fig. . Illustration showing the various approaches used in decompression of tuberculous spondylirtis. kyphus. In active disease intraoperative traction usually results in partial correction of the deformity. When the deformity exceeds 40 it may be wise to first instrument posteriorly achieve deformity correction and then debride and fuse anteriorly. Posterior fixation is however not always necessary but if done helps in deformity correction and graft consolidation in the desired position. For high cervical levels a submandibular approach is used while the classical Southwick Robinson s approach suffices in other patients. Cervicothoracic junction Surgical options in this region are transmanubrial anterior decompression transclavicular anterior decompression and high costo-transversectomy. The transclavicular approach requires either dislocation or surgical fracturing of the clavicle which is morbid. In addition access to the spine is always anterolateral and oblique. In comparison the transmanubrial approach requires splitting of only the manubrium which is easily rejoined and heals without nonunion saves the thoracic duct from iatrogenic damage and most importantly allows direct anterior access to the spinal column for easy grafting and fixation. Management of Lumbosacral Tuberculosis Backache is an important sequelae of the disease and is present in 54 of the cases bearing a direct relation to the number of vertebrae involved and the abnormal lumbo-sacral Any change in Lumbosacral angles to less than 10 will usually result in accelerated degeneration and pain. Hence surgery may be aggressively advocated in cases of acute deformity but no deficit. Role of thoracoscopic surgery Thoracoscopic surgery is being used for drainage of nonresolving abscesses and for the treatment of spinal tuberculosis with paraplegia Spinal Tuberculosis 45 although its efficacy is yet to approach that of open surgery. The main advantage of this .
