IJCM  Vol.8 No.12 , December 2017
Treatment of Thoracic Spine Tuberculosis by Paraspinal Muscle Gap Approach
Abstract: Objective: To evaluate the clinical feasibility and efficacy in treatment of thoracic tuberculosis via paraspinal approach. Methods: From June 2011 to August 2016, 24 patients with mono-segmental thoracic spine tuberculosis were treated by transfacet debridement combined with bone grafting and internal fixation through paraspinal approach. There were 11 males and 13 females with age ranging from 21 to 63 years (average, 39.5). There were 3 patients in T4/5, 2 patients in T5/6, 3 patients in T7/8, 3 patients in T8/9, 4 patients in T9/10, 3 patients in T10/11, and 6 patients in T11/12. Patients had different degraded local kyphosis deformity shown on X-ray, and different degraded bone destruction and abscess in thoracic spine shown on CT and MRI before the operation. All of the patients before the regular anti tuberculosis treatment for 2 to 4 weeks, the surgical approach used by paraspinal muscle approach, postoperative regular anti tuberculosis treatment for 9 to 12 weeks. Record the clinical symptoms of patients before and after surgery, preoperative Frankel functional classification of spinal cord injury, the operative time, intraoperative blood loss, postoperative ESR, CRP, complications, VAS score, ODI score and Cobb angle changes, imaging check regularly to evaluate the fusion and follow-up of nerve functional recovery. Results: The average operation time was 198 min. The average blood loss was 436 ml. There were no severe complications during and after operation. All patients were followed up for 1 year to 2 years, average 1.5 years of follow-up, the clinical symptoms improved significantly after operation and last follow-up ESR, CRP, VAS score, ODI score and Cobb angle were significantly improved after operation (P < 0.05), grade I Eck fusion, the fusion rate was 100% and the neurological function were improved. Conclusion: on the basis of strict anti tuberculosis chemotherapy, the use of paraspinal muscle gap approach for the treatment of thoracic tuberculosis is less invasive, less destructive to spinal stability, and can achieve obvious curative effect. It is worthy of clinical application.
Cite this paper: Zheng, J. , Liu, S. , Hu, B. and Li, J. (2017) Treatment of Thoracic Spine Tuberculosis by Paraspinal Muscle Gap Approach. International Journal of Clinical Medicine, 8, 639-651. doi: 10.4236/ijcm.2017.812060.

[1]   McLain, R.F. and Isada, C. (2004) Spinal Tuberculosis Deserves a Place on the Radar Screen. Cleveland Clinic Journal of Medicine, 71, 537-549.

[2]   Huan, Y.W., Wang, Q.P., Dai, X.W., et al. (1998) National Thoracic Spinal Cord and Spinal Canal Observation and Measurement. Journal of Cervical and Lumbago, 19, 173-175.

[3]   Zhang, Z.H., Li, L.T., Luo, F., et al. (2014) The Early Diagnosis of Mild Spinal Tuberculosis and Outcomes of Nonoperative Treatment. Chinese Journal of Orthopaedic Trauma, 34, 177-182.

[4]   Soares do Brito, J., Batista, N., Tirado, A., et al. (2013) Surgical Treatment of Spinal Tuberculosis: An Orthopedic Service Experience. Acta Medica Portuguesa, 26, 349-356.

[5]   Moon, M.S. (2014) Tuberculosis of Spine: Current Views in Diagnosis and Management. Asian Spine Journal, 8, 97-111.

[6]   Jutte, P.C. and van Loenhout-Rooyackers, J.H. (2006) Routine Surgery in Addition to Chemotherapy for Treating Spinal Tuberculosis. The Cochrane Database of Systematic Reviews, 5, Article ID: CD004532.

[7]   Issack, P.S. and Boachie-Adjei, O. (2012) Surgical Correction of Kyphotic Deformity in Spinal Tuberculosis. International Orthopaedics, 36, 353-357.

[8]   Meena, S., Mittal, S. and Chowdhary, B. (2014) Spinal Tuberculosis: Which Is the Best Surgical Approach? Medical Principles and Practice, 23, 96.

[9]   Eck, K.R., Lenke, L.G., Bridwell, K.H., et al. (2000) Radiographic Assessment of Anterior Titanium Mesh Cages. Journal of Spinal Disorders, 13, 501-510.

[10]   Mehta, J.S. and Bhojraj, S.Y. (2001) Tuberculosis of the Thoracic Spine. A Classi-Fication Based on the Selection of Surgical Strategies. The Journal of Bone and Joint Surgery. British Volume, 83, 859-863.

[11]   Jain, A.K. and Jain, S. (2012) Instrumented Stabilization in Spinal Tuberculosis. International Orthopaedics, 36, 285-292.

[12]   Cui, X., Li, L.T. and Ma, Y.Z. (2016) Anterior and Posterior Instrumentation with Different Debridement and Grafting Procedures for Multi-Level Contiguous Thoracic Spinal Tuberculosis. Orthopaedic Surgery, 8, 454-461.

[13]   Ahsan, K. and Sakeb, N. (2016) Single-Stage Posterior Instrumentation for Progressive Tubercular Thoracic and Thoracolumbar Kyphosis. Journal of Orthopaedic Surgery (Hong Kong), 24, 344-349.

[14]   Shi, J., Yue, X., Niu, N., et al. (2016) Application of a Modified Thoracoabdominal Approach That Avoids Cutting Open the Costal Portion of Diaphragm during Anterior Thoracolumbar Spine Surgery. European Spine Journal, Epub Ahead of Print.

[15]   Fan, S.W., Hu, Z.J., Qian, Q., et al. (2009) Comparative Study of Posterior Lumbar Interbody Fusion with Small Incision and Conventional Open Surgery. Zhonghua Department of Orthopedics, 29, 1000-1004.

[16]   Wiltse, L.L., Bateman, J.G., Hutchinson, R.H., et al. (1968) The Paraspinal Sacrospinalis-Splitting Approach to the Lumbar Spine. The Journal of Bone and Joint Surgery. American Volume, 50, 919-926.

[17]   Street, J.T., Andrew Glennie, R., Dea, N., et al. (2016) A Comparison of the Wiltse versus Midline Approaches in Degenerative Conditions of the Lumbar Spine. Journal of Neurosurgery: Spine, 25, 332-338.

[18]   Hyun, S.J., Kim, Y.B., Kim, Y.S., et al. (2007) Postoperative Changes in Paraspinal Muscle Volume: Comparison between Paramedian Interfacial and Midline Approaches for Lumbar Fusion. Journal of Korean Medical Science, 22, 646-651.

[19]   Xu, Y., Xu, H. and Li, F. (2017) Paraspinal Approach via Facet Interbody Fusion in the Treatment of Thoracic Tuberculosis. Journal of Orthopaedics, 8, 81-84.

[20]   Wang, G., Zhao, H., Wei, M.J., et al. (2009) Distribution of Isoniazid in Different Tissues of Spinal Tuberculosis. Jiangsu Medicine, 35, 669.