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Transforaminal Posterior Approach Is Effective for Treatment of Lower Thoracic Spine Spondylodiscitis

  • Surgical Technique
  • Published:
HSS Journal ®

Abstract

Background

Patients with lower-thoracic spine pathologies that affect anterior column stability and compress the neural tissues need anterior decompression and reconstruction. Anterior approaches result in long-term morbidities. Posterior laminectomy and fixation alone may not be sufficient to maintain spine stability.

Questions/Purposes

To evaluate the results of a posterior-only transforaminal thoracic interbody fusion approach for patients with thoracic disc space infection in terms of the improvement in neurologic status, resolution of infection, correction of kyphotic deformity, and assessment of post-operative complications.

Methods

A prospective study was done on 40 patients with lower thoracic spine spondylodiscitis. All patients were assessed with pre-operative imaging. Neurologic assessment was performed using the American Spinal Injury Association (ASIA) Impairment Scale and functionally by the modified Japanese Orthopedic Association (JOA) scale. Pre-operative and post-operative white blood cell count, erythrocyte sedimentation rate, and C-reactive protein levels were compared. All patients were operated on through a posterior approach using the transforaminal thoracic interbody fusion for decompression, reconstruction, and anterior fusion.

Results

Mean age of patients was 49 years; mean operative period was 188 min; mean blood loss was 611 mL. Twelve patients’ ASIA scores improved and only two patients’ scores declined. One patient died 11 months post-operatively due to septicemia. The mean follow-up period was 27.8 months. The modified JOA score improved from 6.3 ± 1.6 to 9.5 ± 0.6. The local kyphosis angle was improved from 13.8 to 6.9° post-operatively, with insignificant loss of correction at the end of follow-up. Thirty-eight out of 40 patients had solid anterior fusion at the end of follow-up.

Conclusion

The clinical outcomes of this study showed that the transforaminal thoracic interbody approach is effective for both decompression and anterior reconstruction of the lower thoracic spine in patients with spondylodiscitis.

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Authors and Affiliations

  1. Department of Orthopedic, Spine Surgery, Faculty of Medicine, Ain Shams University, Abbasseya, Cairo, Egypt

    Fady Ibrahim MD, Tameem Mohamed Elkhateeb MD, Abdelrady Abd El-Rady MD & Mohammed Zayan MD

Authors
  1. Fady Ibrahim MD
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  2. Tameem Mohamed Elkhateeb MD
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  3. Abdelrady Abd El-Rady MD
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  4. Mohammed Zayan MD
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Corresponding author

Correspondence to Tameem Mohamed Elkhateeb MD.

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Conflict of Interest

Fady Ibrahim, MD, Tameem Mohamed Elkhateeb, MD, Abdelrady Abd El-Rady, MD, and Mohammed Zayan, MD, declare that they have no conflicts of interest.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

Informed Consent

Informed consent was obtained from all patients for being included in this study.

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Levels of Evidence: Therapeutic Study Level IV

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Ibrahim, F., Elkhateeb, T.M., Abd El-Rady, A. et al. Transforaminal Posterior Approach Is Effective for Treatment of Lower Thoracic Spine Spondylodiscitis. HSS Jrnl 16 (Suppl 2), 515–520 (2020). https://doi.org/10.1007/s11420-019-09688-w

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  • DOI: https://doi.org/10.1007/s11420-019-09688-w

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