Subscapularis Transthoracic Versus Posterolateral Approaches in the Surgical Management of Upper Thoracic Tuberculosis

Abstract

The objective of the present study was to evaluate the clinical, radiological, and functional outcomes of a subscapularis transthoracic surgical approach and a posterolateral surgical approach with debridement, bone graft fusion, and internal fixation for the treatment of upper thoracic tuberculosis.There is currently debate over the best surgical approach for the treatment of upper thoracic tuberculosis. Traditionally, the subscapularis transthoracic approach has been preferred; however, the posterolateral approach has gained popularity in the past few years.A prospective, consecutive cohort of 43 upper thoracic tuberculosis patients with a mean age of 39 years (range: 20–52 years) was followed up for a minimum of 12 months (range: 12–60 months). Patients were randomly divided into 2 groups. Group A (n = 21) was treated by the subscapularis transthoracic approach and group B (n = 22) was treated by the posterolateral approach. All cases were evaluated for clinical, radiological, and functional outcomes. Intraoperative blood loss, operative duration, intraoperative and postoperative complications, hospital stay, the cure rate, fusion time, and the Frankel scale were used for clinical and functional evaluation, whereas the kyphosis angle was used for radiological evaluation.Grafted bones were fused by 10 months in all cases. There was no statistically significant difference between groups before surgery in terms of gender, age, segmental tuberculosis, erythrocyte sedimentation rate (ESR), Frankel scale, or Cobb's angle (P > 0.05). The average operative duration for Group B was lower than that of Group A. There were no significant differences in intraoperative blood loss, intraoperative and postoperative complications, hospital stay, grafted bone fusion time, or cure rate between groups (P > 0.05). The Cobb's angle correction rate for group B (68.5%) was significantly better than that of group A (30.9%). The neurological score showed significant postoperative improvement in both groups, with no significant difference between the groups.The subscapularis transthoracic approach and the posterolateral approach with debridement, bone graft fusion, and internal fixation are both sufficient and satisfactory for the surgical treatment of upper thoracic tuberculosis. However, the posterolateral approach is superior to the subscapularis transthoracic approach in terms of surgical trauma, operative time, and kyphosis correction.

Comparison of anterior, posterior, and anterior combined with posterior surgical treatment of thoracic and lumbar spinal tuberculosis: a systematic review

“…Twenty-five studies comparing the anterior, posterior, or anterior combined with posterior approach in treating spinal tuberculosis in the thoracic and lumbar regions were identified. 11 – 35 Table 1 summarizes the characteristics of the included studies. Among the 25 studies, the anterior surgical approach mainly referred to anterior debridement, decompression, and bone grafting with different fixations in a one- or two-stage procedure; the posterior surgical approach mainly referred to posterior debridement, decompression, and bone grafting with different fixations in a one- or two-stage procedure; and the anterior combined with posterior surgical approach referred to anterior and posterior (or posterior and anterior) debridement, decompression, and bone grafting with different fixations in a one- or two-stage procedure.…”

“…Twenty studies 11 , 12 , 14 , 16 – 18 , 20 , 22 – 26 , 28 – 35 reported the preoperative kyphosis angle and correction of the kyphosis angle in patients with thoracic and lumbar spinal tuberculosis ( Table 3 ).…”

Trends in Spinal Surgery for Pott’s Disease (2000-2016): An Overview and Bibliometric Study

“…We excluded 1 after full-text review for lack of a surgical arm, and we retained 5. 6 – 10 Key Question 2 . We identified 503 studies from our search strategy and retained 287 meeting our prestated criteria; 266 in adults and 21 in children.…”

“…From a single RCT, ineffective control with anti-TB drugs AND one of the following: larger sequestrum formation, or sinus formation, or larger abscess, or vertebral collapse, or progressive kyphosis, or neurologic deficit. 7 Thoracic, lumbar spinal TB. One RCT required all of the following: Frankel grading D and E, severe back pain, larger sequestrum formation and significant spinal instability.…”

“…From a single RCT, ineffective control with anti-TB drugs AND one of the following: larger sequestrum formation, or sinus formation, or larger abscess, or vertebral collapse, or progressive kyphosis, or neurologic deficit. 7 …”