Posterolateral Approach to the Thoracic Spine for Spinal Tuberculosis: A Technical Note and an Analysis of Results

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Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 40-46 | Gautam Zaveri

DOI:10.13107/jcorth.2022.v07i01.465

Author: Gautam Zaveri 

[1] Department of Spine Surgery, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India

 

Address of Correspondence
Dr. Gauta Zaveri,
Department of Spine Surgery, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India.
E-mail: gautamzaveri1969@gmail.com

Abstract

Surgical pathologies in the thoracic spine are principally located anteriorly within the vertebral body resulting in vertebral body destruction, kyphotic deformity, and anterior or anterolateral compression of the spinal cord. Adequate decompression of the neural elements and vertebral body reconstruction requires access to the anterior spinal column. The posterolateral approach through a posterior midline incision allows circumferential spinal cord decompression, anterior column reconstruction, correction of thoracic kyphosis, and posterior spinal stabilization to be safely performed through a single incision, at a single sitting with excellent outcomes.

Keywords: Thoracic spine tuberculosis, Posterolateral approaches, Transpedicular approach, Costotransversectomy approach

References

  1. Tuli SM, editor. Tuberculosis of the Skeletal System. 3rd ed. New Delhi, India: Jaypee Brothers Medical Publishers Ltd.; 2004.
  2. Jain AK, Aggarwal A, Mehrotra G. Corelation of canal encroachment with neurological deficit in tuberculosis of the spine. Int Orthop 1999;23:85-96.
  3. Zaveri G. Posterior approaches for management of spinal tuberculosis. In: Rajasekaran S, editor. ASSI Textbook of Spinal Infections and Trauma. 1st ed. New Delhi, India: Jaypee Brothers Medical Publishers Ltd.; 2011. p. 225-36.
  4. Zaveri G. The role of posterior surgery in spinal tuberculosis. ArgoSpine News J 2011;23:112-9.
  5. Mirkovic S, Garfin SR. Costotransversectomy: A posterolateral approach to the thoracic spine. Orthopaedics 1993;3:221-4.
  6. Elsamadicy AA, Adogwa O, Sergesketter A, Lydon E, Bagley CA, Karikari IO. Posterolateral thoracic decompression with anterior column cage reconstruction versus decompression alone for spinal metastases with cord compression: Analysis of perioperative complications and outcomes. J Spine Surg 2017;3:609-19.
  7. Sun David TF. Posterolateral approach to the thoracic spine. In: Ramani PS, Marcos M, Keun SJ, editors. WFNS Spine Committee Textbook on Thoracic Spine. 1st ed. New Delhi, India: Jaypee Brother Medical Publishers Ltd.; 2016.
  8. Zaveri G, Kothari M. Tuberculosis of the thoracic spine. In: Zaveri G, Mulukutla R, editors. The ASSI Monographs. Spinal Tuberculosis. Noida, India: Thieme Medical and Scientific Publishers Pvt. Ltd.; 2019. p. 121-44.
  9. Kshettry VR, Healy AT, Jones NG, Mroz TE, Benzel EC. A quantitative analysis of posterolateral approaches to the ventral spinal  canal. Spine J 2015;15:2228-38.
  10. Ahlgren BD, Herkowitz HN. A modified posterolateral approachto the thoracic spine. J Spinal Disord 1995;8:69-75.
  11. Seddon HJ. Pott’s paraplegia, prognosis and treatment. Br J Surg 1935;22:769-99.
  12. Tuli SM. Historical aspects of Pott’s disease (spinal tuberculosis) management. Eur Spine J 2013;22:529-38.
  13. Ito H, Tsuchiya J, Asami G. A new radical operation for Pott’s disease. Report of 10 cases. J Bone Joint Surg Br 1934;16:499-515.
  14. Hodgson AR, Stock FE. Anterior spinal fusion, a preliminary communication on the radical treatment of Pott’s disease and Pott’s paraplegia. Br J Surg 1956;44:266-75.
  15. Rajasekaran S, Soundarapandian S. Progression of kyphosis in tuberculosis of the spine treated with anterior arthrodesis. J Bone Joint Surg Am 1989;71:1314-23.
  16. Moon MS, Woo YK, Lee KS, Ha KY, Kim SS, Sun DH. Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spines. Spine (Phila Pa 1976) 1995;20:1910-6.
  17. Yilmaz C, Selek HY, Gurkan I, Erdemli B, Korkusuz Z. Anterior instrumentation for the treatment of spinal tuberculosis. J Bone
    Joint Surg Am 1999;81:1261-7.
  18. Lubelski D, Abdullah KG, Steinmetz MP, Masters F, Benzel EC, Mroz TE, et al. Lateral extracavitary, costotransversectomy, and transthoracic thoracotomy approaches to the thoracic spine: Review of techniques and complications. J Spinal Disord Tech 2013;26:222-32.
  19. Hardaker WT, Cook WA Jr., Friedman AH, Fitch RD. Bilateral transpedicular decompression and Harrington rod stabilization in the management of severe thoracolumbar burst fractures. Spine (Phila Pa 1976)1992;17:162-71.
  20. Stillerman CB, Chen TC, Day JD, Couldwell WT, Weiss MH. The transfacet pedicle-sparing approach for thoracic disc removal: Cadaveric morphometric analysis and preliminary clinical experience. J Neurosurg 1995;83:971-6.
  21. Zhang P, Peng W, Wang X, Luo C, Xu Z, Zeng H, et al. Minimum 5 year follow up outcomes for single stage transpedicular debridement, posterior instrumentation and fusion in the management of thoracic and thoracolumbar spinal tuberculosis in adults. Br J Neurosurg 2016;30:613-20.
  22. Garg B, Kandwal P, Nagraja UB, Goswami. A, Jayaswal A. Anterior versus posterior for surgical treatment of thoracolumbar tuberculosis. Indian J Orthop 2012;46:165-70.

 

How to Cite this article: Zaveri G. Posterolateral Approach to the Thoracic Spine for Spinal Tuberculosis: A Technical Note and an Analysis of Results. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):40-46.

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