Retrospective feasibility analysis of modified posterior partial vertebrectomy with 360-degree decompression in destructive thoracic spondylodiscitis.

BACKGROUND

Advanced states of vertebral osteomyelitis accompanied by spinal instability, epidural abscess formation, and neurological deficits require surgical decompression, stabilization, and often reconstruction of the anterior and posterior columns. The efficacy of a posterolateral approach with resection of inflammatory tissue, and interbody (titanium cages) and dorsal fusion was investigated and the clinical and radiological parameters (correction of kyphosis and fusion rates) were evaluated.

METHOD

From 2011 to 2014, ten consecutive patients were treated at our institution using the modified technique of a transversecomy without costal resection to decompress neural structures and resect inflammatory tissue in destructive thoracic vertebral osteomyelitis. Flattening of the endplates without complete corpectomy, 360-degree stabilization, and correction of kyphosis by posterior shortening instead of anterior distraction were performed to avoid an additional ventral approach. Clinical and radiological data were retrospectively analyzed.

RESULTS

All ten patients (six male and four female, mean age, 66 years) suffered from severe and destructive osteomyelitis. Surgery was performed successfully in all ten patients. Mean surgical time was 308 min. Mean follow-up was 19 months (range, 2-32 months). Neither approach-related or pulmonary complications nor recurrence of osteomyelitis were observed. All patients experienced pain relief after the procedure (mean back pain VAS was 8.8 pre-treatment and 3.2 at the final follow-up). Fusion was observed in all patients on the basis of computerized tomography scans. The mean radiological segmental kyphosis was corrected from 20° preoperatively to 7° after surgery and 9° at the final follow-up.

CONCLUSIONS

The modified posterior transversectomy with 360-degree decompression and anterior wall reconstruction with titanium cages in combination with posterior instrumentation for sagittal alignment correction is a reliable, effective, and safe treatment option.