A retrospective clinical study of the therapeutic effect of subscapularis transthoracic and posterolateral approach for upper thoracic tuberculosis

Abstract

Objective To compare the therapeutic effect of debridement,bony fusion and internal fixation through subscapularis transthoracic and posterolateral approach in treating upper thoracic tuberculosis.Methods Between January 2002 to February 2014,a total of 43 patients with upper thoracic tuberculosis were analyzed retrospectively.There were 21 patients in subscapularis transthoracic approach group and 22 patients in posterolateral approach group.Several parameters of the two groups were compared,including gender,age,segmental tuberculosis,intraoperative blood loss,operative time,complications of operation,hospital stay,the cure rate,the Cobb angle,Frankel scale and so on.Results There was no significant difference in gender,age,segmental tuberculosis,ESR,Frankel scale,Cobb angle between the two groups before surgery.The operative time was 196± 10 min in subscapularis transthoracic approach group,whereas it was 142±13 min in posterolateral approach group.The operative time of subscapularis transthoracic approach group was significantly longer than posterolateral approach group.There was no significant difference in intraoperative blood loss,complications of operation,hospital stay and the cure rate.The followed up of subscapularis transthoracic approach group and posterolateral approach group was 28.0± 14.7 months and 27.3± 15.5 months respectively.The preoperative Cobb angle was 36.5°±4.8° and the postoperative Cobb angle was 24.8°±5.6° in subscapularis transthoracic approach group.The correction rate was 30.9％.The preoperative Cobb angle was 34.5°±5.2° and the postoperative Cobb angle was 10.2°±2.6° in posterolateral approach group.The correction rate was 68.5％.Thus,the correction rate of posterolateral approach group was significant better than subscapularis transthoracic approach group.The neurological score of Frankel scale was significantly restored in two groups after operation,and there was no significant difference between two groups.Conclusion For upper thoracic tuberculosis,the therapeutic effect of debridement,bony fusion and internal fixation through subscapularis transthoracic and posterolateral approach could achieve the same good clinical results.However,the posterolateral approach was better than subscapularis transthoracic approach in surgical trauma,surgical duration and kyphosis correction.Therefore,it is recommended to use the posterolateral approach in treating upper thoracic tuberculosis. Key words: Thoracic vertebrae; Spine; Tuberculosis; Surgical procedures, operative