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Transforaminal thoracic interbody fusion

Treatment of thoracic myelopathy caused by anterior compression

Transforaminale thorakale Spondylodese

Therapie der durch eine anteriore Kompression bedingten thorakalen Myelopathie

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Abstract

Background

The aim of this study was to evaluate the early clinical safety and efficacy of transforaminal thoracic interbody fusion (TTIF) with interbody cage application for thoracic myelopathy caused by anterior compression (TMAC).

Methods

A total of 10 patients who underwent TTIF for TMAC from July 2009 to July 2014 were retrospectively reviewed. Thoracic spinal lesions included thoracic disc herniation, thoracic ossification of posterior longitudinal ligament, thoracic vertebral compression fracture, and thoracic spine fracture dislocation. Demographic data, radiological findings as well as operative information were collected. Postoperative functional outcomes evaluated by the modified Japanese Orthopedic Association (mJOA) score and complications were analyzed.

Results

The mean operation time was 186.5 min (range 110–315 min), the mean operative blood loss was 845.0 ml (range 400–2000 ml), and the mean recumbent period was 2.7 days (range 1–8 days). During the follow-up period all patients exhibited significant improvements in neurological deficits. The mJOA score improved from a mean of 6.1 ± 1.7 preoperatively to 7.4 ± 1.6 postoperatively and to 9.3 ± 1.6 at final follow-up (P <0.01), with an overall recovery rate of 69.0 ± 26.1%. Solid fusion was observed in all cases. A wound infection was found in one case, in which the patient recovered with no residual neurological deficits after surgical debridement and administration of intravenous antibiotics. No cage-related complications were found in this study.

Conclusion

The use of TTIF with cage application can be an effective treatment method of thoracic myelopathy caused by anterior compression, with favorable efficacy and safety.

Zusammenfassung

Hintergrund

Ziel der Studie war es, die frühe klinische Sicherheit und Wirksamkeit der transforaminalen thorakalen Spondylodese („transforaminal thoracic interbody fusion“ [TTIF]) mit intervertebralem Cage bei thorakaler Myelopathie bedingt durch eine anteriore Kompression (TMAC) zu ermitteln.

Methoden

Insgesamt 10 Patienten, die zwischen Juli 2009 und Juli 2014 eine TTIF bei TMAC erhalten hatten, wurden retrospektiv untersucht. Thorakale Wirbelsäulenschäden umfassten thorakale Bandscheibenvorfälle, thorakale Ossifikationen des Lig. longitudinale posterius, Kompressionsfrakturen thorakaler Wirbelkörper und Luxationsfrakturen der Brustwirbelsäule. Demografische Daten, radiologische Befunde und chirurgische Angaben wurden gesammelt. Mit dem modifizierten Japanese-Orthopedic-Association(mJOA)-Score bewertete postoperative funktionelle Behandlungsergebnisse und Komplikationen wurden analysiert.

Ergebnisse

Die mittlere Operationsdauer betrug 186.5 min (Bereich: 110–315 min), der mittlere operative Blutverlust 845,0 ml (Bereich: 400–2000 ml) und die mittlere Liegezeit 2,7 Tage (Bereich: 1–8 Tage). Im Follow-up zeigten alle Patienten signifikante Verbesserungen der neurologischen Störungen. Der mJOA-Score verbesserte sich von durchschnittlich 6,1 ± 1,7 präoperativ auf 7,4 ± 1,6 postoperativ und auf 9,3  ± 1,6 in der letzten Follow-up-Untersuchung (P <0,01) bei einer Gesamtgenesungsrate von 69,0 ± 26,1 %. In allen Fällen war eine stabile Spondylodese zu verzeichnen. Eine Wundinfektion fand sich in einem Fall, wobei sich der Patient nach chirurgischem Débridement und intravenöser Antibiotikatherapie erholte und keine bleibenden neurologischen Störungen aufwies. Cage-bedingte Komplikationen traten in dieser Studie nicht auf.

Schlussfolgerung

Die TTIF mit Cage kann eine wirksame und sichere Therapiemethode bei thorakaler Myelopathie bedingt durch eine anteriore Kompression sein.

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Abbreviations

CF:

Compression fracture

FD:

Fracture dislocation

IR:

Improvement rate

mJOA:

Modified Japanese Orthopedic Association scale

PEEK:

Polyetheretherketone

PLIF:

Posterior lumbar interbody fusion

SEP:

Somatosensory evoked potential

TDH:

Thoracic disc herniation

TMAC:

Thoracic myelopathy caused by anterior compression

TOPLL:

Thoracic ossification of posterior longitudinal ligament

TSS:

Thoracic spinal stenosis

TTIF:

Transforaminal thoracic interbody fusion

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Authors and Affiliations

  1. Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dong Cheng District Shuai Fu Yuan No. 1, Beijing, China

    Ling-jia Yu M.D. & Yu Zhao Ph.D.M.D.

  2. Department of Orthopaedics, Beijing Jishuitan Hospital, Beijing, China

    Wen-jing Li Ph.D. M.D.

  3. Department of Trauma & Orthopaedic Surgery, Lister Hospital, Stevenage, UK

    Shi-gong Guo M.D.

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  1. Ling-jia Yu M.D.
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  2. Wen-jing Li Ph.D. M.D.
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  3. Shi-gong Guo M.D.
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  4. Yu Zhao Ph.D.M.D.
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Corresponding author

Correspondence to Yu Zhao Ph.D.M.D..

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Conflict of interest

L. Yu, W. Li, S. Guo and Y. Zhao declare that they have no competing interests.

This study was approved by the institutional review board of Peking Union Medical College Hospital (no. S‑K364). The methods were carried out in accordance with the relevant guidelines. Written informed consent was obtained from all participants in the study at final follow-up at the clinic.

Additional information

Ling-jia Yu and Wen-jing Li contributed equally to this article.

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Yu, Lj., Li, Wj., Guo, Sg. et al. Transforaminal thoracic interbody fusion. Orthopäde 47, 986–992 (2018). https://doi.org/10.1007/s00132-018-3588-6

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