Advertisement

Transforaminal Posterior Approach Is Effective for Treatment of Lower Thoracic Spine Spondylodiscitis

  • Fady Ibrahim
  • Tameem Mohamed ElkhateebEmail author
  • Abdelrady Abd El-Rady
  • Mohammed Zayan
Surgical Technique
  • 6 Downloads

Abstract

Background

Patients with lower-thoracic spine pathologies that affect anterior column stability and compress the neural tissues need anterior decompression and reconstruction. Anterior approaches result in long-term morbidities. Posterior laminectomy and fixation alone may not be sufficient to maintain spine stability.

Questions/Purposes

To evaluate the results of a posterior-only transforaminal thoracic interbody fusion approach for patients with thoracic disc space infection in terms of the improvement in neurologic status, resolution of infection, correction of kyphotic deformity, and assessment of post-operative complications.

Methods

A prospective study was done on 40 patients with lower thoracic spine spondylodiscitis. All patients were assessed with pre-operative imaging. Neurologic assessment was performed using the American Spinal Injury Association (ASIA) Impairment Scale and functionally by the modified Japanese Orthopedic Association (JOA) scale. Pre-operative and post-operative white blood cell count, erythrocyte sedimentation rate, and C-reactive protein levels were compared. All patients were operated on through a posterior approach using the transforaminal thoracic interbody fusion for decompression, reconstruction, and anterior fusion.

Results

Mean age of patients was 49 years; mean operative period was 188 min; mean blood loss was 611 mL. Twelve patients’ ASIA scores improved and only two patients’ scores declined. One patient died 11 months post-operatively due to septicemia. The mean follow-up period was 27.8 months. The modified JOA score improved from 6.3 ± 1.6 to 9.5 ± 0.6. The local kyphosis angle was improved from 13.8 to 6.9° post-operatively, with insignificant loss of correction at the end of follow-up. Thirty-eight out of 40 patients had solid anterior fusion at the end of follow-up.

Conclusion

The clinical outcomes of this study showed that the transforaminal thoracic interbody approach is effective for both decompression and anterior reconstruction of the lower thoracic spine in patients with spondylodiscitis.

Keywords

anterior reconstruction lower thoracic spine spondylodiscitis transforaminal thoracic interbody fusion 

Notes

Compliance with Ethical Standards

Conflict of Interest

Fady Ibrahim, MD, Tameem Mohamed Elkhateeb, MD, Abdelrady Abd El-Rady, MD, and Mohammed Zayan, MD, declare that they have no conflicts of interest.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

Informed Consent

Informed consent was obtained from all patients for being included in this study.

Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.

Supplementary material

11420_2019_9688_MOESM1_ESM.pdf (1.2 mb)
ESM 1 (PDF 1224 kb)
11420_2019_9688_MOESM2_ESM.pdf (1.2 mb)
ESM 2 (PDF 1224 kb)
11420_2019_9688_MOESM3_ESM.pdf (1.2 mb)
ESM 3 (PDF 1224 kb)
11420_2019_9688_MOESM4_ESM.pdf (1.2 mb)
ESM 4 (PDF 1224 kb)

References

  1. 1.
    American Spinal Injury Association. Standard for neurologic and functional classification of spinal cord injury. Chicago; 1992.Google Scholar
  2. 2.
    Benli IT, Kiş M, Akalin S, Citak M, Kanevetçi S, Duman E. The results of anterior radical debridement and anterior instrumentation in Pott’s disease and comparison with other surgical technique. Kobe J Med Sci. 2000;46(1–2):39–68.Google Scholar
  3. 3.
    Blume HG, Rojas CH. Unilateral lumbar interbody fusion (posterior approach) utilizing dowel graft. J Neurol Orthop Surg. 1981;2:171–175.Google Scholar
  4. 4.
    Cloward RB. The treatment of ruptured lumbar intervertebral disc by vertebral body fusion. I. Indications, operative technique, after care. J Neurosurg. 1953;10:154–168.CrossRefGoogle Scholar
  5. 5.
    Fisher CG, Sahajpal V, Keynan O, et al. Accuracy and safety of pedicle screw fixation in thoracic spine trauma. J Neurosurg Spine. 2006;5:520–526.CrossRefGoogle Scholar
  6. 6.
    Garg B, Kandwal P, Nagaraja UB, Goswami A, Jayaswal A. Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis: a retrospective analysis. Indian Orthop. 2012;46(2):165–170.CrossRefGoogle Scholar
  7. 7.
    Guerado E1, Cerván AM. Surgical treatment of spondylodiscitis. An update. Int Orthop. 2012;36(2):413–420.Google Scholar
  8. 8.
    Hackenberg L, Halm H, Bullmann V, et al. Transforaminal lumbar interbody fusion: a safe technique with satisfactory three to five-year results. Eur Spine J. 2004;29:E65–70.Google Scholar
  9. 9.
    Harms J, Jeszenszky D, Stolze D, et al. True spondylolisthesis reduction and more segmental fusion in spondylolisthesis. In: The textbook of spinal surgery. 2nd ed. Philadelphia, PA: Lippincott-Raven; 1997.Google Scholar
  10. 10.
    Harris BM, Hilibrand AS, Savas PE, et al. Transforaminal lumbar interbody fusion: the effect of various instrumentation techniques on the flexibility of the lumbar spine. Spine 2004;29:E65–70.CrossRefGoogle Scholar
  11. 11.
    Hassan K, Elmorshidy E. Anterior versus posterior approach in surgical treatment of tuberculous spondylodiscitis of thoracic and lumbar spine. Eur Spine J. 2016;25(4):1056–1063.CrossRefGoogle Scholar
  12. 12.
    Jaslow IA. Intercorporal bone graft in spinal fusion after disc removal. Surg Gynecol Obstet. 1946;82:215–218.Google Scholar
  13. 13.
    Karapinar L, Erel N, Ozturk H, et al. Pedicle screw placement with a free hand technique in thoracolumbar spine: is it safe? J Spinal Disord Tech. 2008;21:63–67.CrossRefGoogle Scholar
  14. 14.
    Kato S, Oshima Y, Oka H, et al. Comparison of the Japanese Orthopaedic Association (JOA) score and modified JOA (mJOA) score for the assessment of cervical myelopathy: a multicenter observational study. PLoS One. 2015;10(4): e0123022.Google Scholar
  15. 15.
    Kim YJ, Lenke LG, Bridwell KH, et al. Free hand pedicle screw placement in the thoracic spine: is it safe? Spine. 2004;29:333–342.CrossRefGoogle Scholar
  16. 16.
    Lee MC, Wang MY, Fessler RG, Liauw J, Kim DH. Instrumentation in patients with spinal infection. Neurosurg Focus. 2004;17(6):E7.CrossRefGoogle Scholar
  17. 17.
    Lim JK, Kim SM, Jo DJ, Lee TO. Anterior interbody grafting and instrumentation for advanced spondylodiscitis. J Korean Neurosurg. 2008;43:5–10.CrossRefGoogle Scholar
  18. 18.
    Lowe TG, Tahernia AD, O’Brien MF, et al. Unilateral transforaminal posterior lumbar interbody fusion (TLIF): indications, technique, and 2-year results. J Spinal Disord Tech. 2002;15:31–38.CrossRefGoogle Scholar
  19. 19.
    Machino M, Yukawa Y, Ito K, Nakashima H, Kato F. A new thoracic reconstruction technique “transforaminal thoracic interbody fusion”: a preliminary report of clinical outcomes. Spine (Phila Pa 1976). 2010;35(19): E1000–1005.CrossRefGoogle Scholar
  20. 20.
    Ozalay M, Sahin O, Derincek A, et al. Non-tuberculous thoracic and lumbar spondylodiscitis: single-stage anterior debridement and reconstruction, combined with posterior instrumentation and grafting. Acta Orthop Belg. 2010;76:100–106.Google Scholar
  21. 21.
    Pee YH, Park JD, Choi YG, Lee SH. Anterior debridement and fusion followed by posterior pedicle screw fixation in pyogenic spondylodiscitis: autologous iliac bone struts versus cage. J Neurosurg Spine. 2008;8:405–412.CrossRefGoogle Scholar
  22. 22.
    Potter BK, Freedman BA, Verwiebe EG, et al. Transforaminal lumbar interbody fusion: clinical and radiographic results and complications in 100 consecutive patients. J Spinal Disord Tech. 2005;18:337–346.CrossRefGoogle Scholar
  23. 23.
    Qureshi MA, Khalique AB, Afzal W, Pasha IF, Aebi M. Surgical management of contiguous multilevel thoracolumbar tuberculous spondylitis. Eur Spine J. 2013;22(Suppl 4):618–623.CrossRefGoogle Scholar
  24. 24.
    Rosenberg WS, Mummaneni PV. Transforaminal lumbar interbody fusion: technique, complications, and early results. Neurosurgery. 2001;48:569–574.CrossRefGoogle Scholar
  25. 25.
    Salehi SA, Tawk R, Ganju A, et al. Image-guided spine surgery. Transforaminal lumbar interbody fusion: surgical technique and results in 24 patients. Neurosurgery. 2004;54:368–374.CrossRefGoogle Scholar
  26. 26.
    Taneichi H, Suda K, Kajino T, et al. Unilateral transforaminal lumbar interbody fusion and bilateral anterior-column fixation with two Brantigan I/F cages per level: clinical outcomes during a minimum 2-year follow-up period. J Neurosurg Spine. 2006;4:198–205.CrossRefGoogle Scholar
  27. 27.
    Zhong W, Xiong G, Wang B, Lu C, Dai Z, Lv G. Surgical management for thoracic spinal tuberculosis posterior only versus anterior video-assisted thoracoscopic surgery. PLoS One. 2015;10(3):e0119759.CrossRefGoogle Scholar

Copyright information

© Hospital for Special Surgery 2019

Authors and Affiliations

  1. 1.Department of Orthopedic, Spine Surgery, Faculty of MedicineAin Shams UniversityAbbasseyaEgypt

Personalised recommendations