Costotransversectomy Approach for Treatment of Thoracic Spine Infection

Abstract

Introduction: Traditionally, surgery for infective spondylodiscitis involving the anterior and posterior columns is staged or sequential and is performed during the same anesthesia session. It is well suited for direct debridement, reconstruction of the anterior column, correcting the kyphotic deformity, and posterior decompression of the spinal cord. The spine, however, may be unstable between stages. Sequentially staged operations require a long overall operating time and chest tube placement because of thoracotomy for the thoracic spine, thereby increasing the risk of complications. Purposes: To evaluate the clinical outcome and infection control of spondylodiscitis after debridement of the thoracic spine by the modified costotransversectomy Methods: Between November 2009 and October 2012, a total of 11 patients (7 male, 4 female) with pyogenic and mycobacterial thoracic spondylodiscitis underwent one-stage modified costotransversectomy for disc and endplate debridement, disc space reconstruction, and posterior instrumentation. Results: Each patient displayed clinical and laboratory improvement after the surgical intervention. The average preoperative C-reactive protein (CRP) level and peripheral white blood cell count (WBC) were compared with the levels 7 days postoperatively: CRP (166.2 ± 31.4 vs. 77.5 ± 13.9; p = 0.002) and WBC (13.7 ± 1.1 vs. 10.7 ± 0.5; p = 0.009). Clinical functional results measured by the Oswestry Disability Index preoperatively and at discharge were 69% and 53%, respectively, indicating more than 10% improvement (p ＜ 0.001). The average kyphosis angle postoperatively was 14.7° ± 2.1° vs. 23.1° ± 2.6° preoperatively (p ＜ 0.001). Conclusions: The modified costotransversectomy approach for treating thoracic spine infection is a safe, effect alternative treatment with fewer complications than with traditional surgery and encouraging clinical outcomes.