Preliminary experience in treating thoracic spinal tuberculosis via a posterior modified transfacet debridement, instrumentation, and interbody fusion

Abstract

BackgroundPosterior transfacet approach has been proved to be a safe and effective access to treat thoracic disc herniation. However, the therapeutic effect and safety of modified transfacet approach for treating thoracic spinal tuberculosis (TST) has not been reported in the clinical literature. In this study, the clinical efficacy and safety of a single-stage posterior modified transfacet debridement, posterior instrumentation, and interbody fusion for treating TST were retrospectively evaluated.Patients and methodsFrom 2009 to 2014, 37 patients with TST underwent a posterior modified transfacet debridement, interbody fusion following posterior instrumentation, under the cover of 18 months of antituberculosis chemotherapy. The patients were evaluated preoperatively and postoperatively in terms of Frankel Grade, visual analog scale (VAS) pain score, kyphotic Cobb angle, and bony fusion.ResultsThe follow-up time was 39.8 ± 5.1 months (29–50 months). No postoperative complication or recurrence of spinal tuberculosis was observed. Definitive bony fusion was achieved in all patients. At the final follow-up, 2 cases were rated as Frankel grade D, 35 as grade E. VAS was recovered from 8.4 ± 1.0 cm to 0.4 ± 0.8 cm. The kyphotic angles were corrected from 29.4 ± 10.9° to 17.6 ± 6.3°. Using the Kirkaldy-Willis criteria, functional outcome was excellent in 29 patients, good in 7, and fair in 1.ConclusionsOur preliminary results showed that single-stage posterior modified transfacet debridement, posterior instrumentation, and interbody fusion are effective and safe surgical options for treating TST.

Bilateral Percutaneous Transpedicular Drainage under Local Anesthesia for Thoracic Tuberculous Spondylitis

“…A combined anteroposterior approach has also been proposed, but this approach has been associated with a high rate of morbidity and mortality. 25 26 27 28 The posterior approach for debridement and instrument fixation is still applied in the management of thoracic or lumbar tuberculous spondylitis. 15 18 20 29 30 31 Our patient started to complain of pain near the left scapula 3 years before he presented at our hospital.…”

Evaluation of the efficacy of OLIF combined posterior internal fixation for single-segment lumbar tuberculosis: a single-center retrospective cohort study

“…On the contrary, the operative time and operative blood loss reported in this study were both lower than those of only posterior approach surgery for lumbar TB as we previously reported [ 14 ]. We thought there may be the following reasons: (1) During OLIF surgery, the surgeon could reach the lesion segment and perform the procedures such as TB lesion debridement, bone grafting and fusion under the direct vision [ 15 ]; however, in the traditional posterior approach surgery, these above procedures were all conducted in a blind field of vision especially the opposite side of the TB lesion [ 16 ]. (2) In OLIF combined posterior internal fixation surgery, the surgeon did not need to open the spinal canal [ 17 ]; but in posterior surgery, the surgeon need to remove at least one side of the lamina and facet articular process to create a window for operations such as debridement of TB lesions [ 18 ].…”

Impact Factors on Posterior Modified Transfacet Debridement for Thoracic Spinal Tuberculosis Basing on Regression and Classification Analysis

“…And both models have high R 2 values. e posterior transfacet-modified approach has been reported to be a safe and effective method for the treatment of thoracic spinal tuberculosis (TST) with low morbidity in the precious report [7]. However, the impact factors of the surgical approach for TST have not been intensively analyzed.…”

“…Between 2009 and 2014, the authors treated 37 consecutive patients with TST via a modified transfacet approach [7].…”

“…(3) Posterior approach: posterior approaches such as posterolateral, pedicle, or posterior approaches and their variants have been proven to be a safe and effective method for the treatment of thoracic disc herniation (TDH) with a relatively low incidence. In addition, posterior approach can better correct kyphosis, which is the most common complication of TST [7]. Some studies believed that, in terms of operation time, the combined approach was longer than the anterior approach, but there was no statistical difference with the posterior approach.…”