Anterior Transthoracic Approach for the Treatment of Thoracic Tubercular Spondylodiscitis - A Retrospective Study

Abstract

Study design:   A Retrospective study. Purpose: To determine the clinical and radiological outcome of thoracic tuberculous spondylodiscitis through anterior transthoracic approach. Methods: We retrospectively reviewed 38 patients with thoracic tubercular spondylodiscitis in our hospital between January 2010 to December 2016. The indication for surgery was the neurological deficit and refractory cold abscess not responding or worsening with antitubercular chemotherapy, spinal instability, and kyphotic deformity > 40°. All patients underwent surgery by the anterior transthoracic approach and had debridement, decompression, rigid fixation, and placement of bone autograft.  All the patients were evaluated clinically and radiologically on each follow-up. Frankel grading and VAS score were calculated. Results: Total 38 patients in which 13 males and 35 females with a mean age of 45.02 years, a mean follow up of 47.84 months were included in our study. Preoperative neurological deficits were present in 34 patients out of which 31 patients improved, 2 remained the same after surgery according to Frankel grading and one mortality took place on the 8th postoperative day due to acute myocardial infarction.  Average VAS score was 7.4 at admission which was improved to 3.2 at final follow up. Preoperative kyphosis in the thoracic spine was 42.2º (22º-54º), which was corrected to mean of 25.3º (14º-29º) postoperatively. One patient developed chest infection one month after the surgery for which left sided pneumenectomy was done. There was no graft and implant-related complication. Conclusion: Treatment of thoracic tubercular spondylodiscitis with anterior transthoracic approach provides adequate debridement thorough decompression of the neural tissue with good deformity correction and also achieves good clinical, neurological, radiological and serological outcomes.