Posterior Extensive Circumferential Decompressive Reconstructive Technique in Surgical Treatment of Upper Thoracic Spine Compressive Lesions

Abstract

Complexity in ventral surgical exposure and presence of scapula and large parascapular musculature during posterior surgery are the main obstacles in operative treatment of upper thoracic spine compressive lesions (UTSCLs), such as trauma, tuberculosis, and neoplasm. Recently, the advantages of combined ventrodorsal surgery could be successfully gained using a 1-stage posterior salvage technique with enough accessibility to all 3 spinal columns. This was a retrospective evaluation of 35 patients with UTSCLs treated by the posterior extensive circumferential decompressive reconstructive (PECDR) procedure. Traumatic, tuberculosis, and neoplastic lesions were involved between 2009 and 2012. All patients were examined pre- and postoperatively and during follow-up clinically (pain by visual analog scale), neurologically (sensory and motor deficit by American Spinal Injury Association grading), functionally (Oswestry Disability Index), radiologically (kyphosis correction, loss of correction, and fusion time), and with laboratory investigations in patients with tuberculosis. Two authors plus an independent observer performed the final clinical, neurologic, and radiologic examination. Operative time, hospital stay, blood loss, and complications were documented. The mean follow-up period was 36 ± 5.5 months. Local symptoms, deformity correction, and neurologic recovery significantly improved postoperatively. Solid fusion was evident in 32 cases. No major complications were reported. Three patients developed wound infection and 3 had intercostal neuralgia; both complications were resolved uneventfully and did not influence the outcomes. Because of difficult ventral exposure, the PECDR technique is a feasible tool for maintained deformity correction, bony fusion, thecal decompression, and functional improvement in surgical treatment of UTSCLs. However, tuberculosis had better satisfactory results than traumatic and neoplastic lesions.