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One-stage surgical treatment of upper thoracic spinal tuberculosis by posterolateral costotransversectomy using an extrapleural approach

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Due to the complexity of the anatomical structure and the difficulty of exposing the surgical area, the surgery for spinal tuberculosis in the upper thoracic vertebra (above T6–T7) is complicated and the prognosis is not good. This study aimed to investigate the clinical effects of posterolateral costotransversectomy using an extrapleural approach in patients with upper thoracic spinal tuberculosis.

Methods

This was a retrospective analysis of 132 patients (including 78 males and 54 females) with upper thoracic spinal tuberculosis who underwent one-stage internal fixation and debridement followed by combined interbody and posterior fusion via posterolateral costotransversectomy using an extrapleural approach. The age ranged from 23 to 82 years (54.5 ± 13.2 years). Lesion segments were distributed from T2 to T7. According to Frankel’s spinal cord function evaluation, there were 2 cases of grade A, 6 of grade B, 6 of grade C, 12 of grade D, and 106 of grade E. The preoperative Cobb angle was 16–40° (29.1° ± 6.5°). Operation time, bleeding volume, incision healing, bone graft fusion, deformity correction, and improvement of nerve function were analyzed.

Results

The operation time ranged from 2.8 to 4.1 h (3.4 ± 0.3 h), and blood loss ranged from 350 to 550 mL (460 ± 47 mL). All incisions healed in the first stage. The bone graft fusion time was 3–6 months (median of 4 months). There was no loosening or broken of the internal fixation. The C-reactive protein and erythrocyte sedimentation rate were significantly improved at the end of follow-up in comparison with before surgery. The Cobb angle of the fusion segment was corrected and ranged from 5° to 17° (average of 10.7° ± 3.3°) at the end of follow-up. The nerve function of all patients improved at different degrees by the time of the last follow-up. In the last follow-up, the Frankel grade distribution was 1 case in B grade, 2 cases in grade C, 6 cases in grade D, and 123 cases in grade E.

Conclusion

Posterolateral costotransversectomy using an extrapleural approach is a safe and effective surgical method that can expose the upper thoracic spine lesions and reduce trauma.

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Data availability

The analyzed data sets generated during the study are available from the corresponding author on reasonable request.

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Funding

This study was funded by the Medicine & Health Science and Technology Project of Zhejiang province, China (grant number 2018KY605) and the Science and Technology Development Program of Hangzhou, China (grant number 20180417A04). And the funding body has no role in designing research, collecting, analyzing and interpreting data and writing manuscripts.

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Author notes

  1. Shiyuan Shi and Xiaozhang Ying contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedics, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, No 208 Huancheng East Rd, Zhejiang Province, Hangzhou, 310003, China

    Shiyuan Shi, Xiaozhang Ying, Jun Fei & Shengping Hu

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  1. Shiyuan Shi
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  2. Xiaozhang Ying
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  3. Jun Fei
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Contributions

SYS performed the research, analyzed the data, and wrote the manuscript. XZY designed the research, analyzed the data, and wrote the manuscript. JF and SPH collected the data and analyzed the data. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xiaozhang Ying.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This work was approved by the Ethics Committee of the Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Written informed consent was obtained from all patients.

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Shi, S., Ying, X., Fei, J. et al. One-stage surgical treatment of upper thoracic spinal tuberculosis by posterolateral costotransversectomy using an extrapleural approach. Arch Orthop Trauma Surg 142, 2635–2644 (2022). https://doi.org/10.1007/s00402-021-04007-7

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  • DOI: https://doi.org/10.1007/s00402-021-04007-7

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