Anterolateral versus Transpedicular Decompression with Posterior Instrumentation: A Randomized Prospective Study in...

Surgical decompression is necessary for anterior paradiscal-type thoracic spine tuberculosis with a neurological deficit; nevertheless, if pedicle screw fixation is unsuccessful, laminectomy may result in pan-vertebral instability. No available studies compare traditional anterolateral decompression (ALD) with the convenient, less extensive technique of transpedicular decompression (TPD).

This randomized comparative study of 20 cases of thoracic spine tuberculosis (T2-T12) used a posterior midline surgical approach with pedicle screw instrumentation. Diseased pedicle removal by eggshell technique (TPD) was compared with decompression by removal of the posterior part of the rib, transverse process, pedicle, and posterolateral part of the diseased vertebral body (ALD).

Both groups had similar lengths of skin incision, intraoperative blood loss, and blood transfusion, but the duration of surgery was significantly less (p-value 0.019) in the TPD (156.5 minutes) than in the ALD group (184.5 minutes). Additional hemi-laminotomy was needed in two cases of TP, in the absence of liquid pus. Both groups showed similar neurological recovery except for one case of multidrug resistance in the ALD group. Improvements in the modified Japanese Orthopedics Association score (p=0.719); visual analog scale (p=0.259) and Nurick scale (p=0.387) had no statistical difference between the two groups. Mean kyphosis correction of 6.64⁰ and 6.45⁰ and mean loss of correction at 2-years were 4.74⁰ and 1.98⁰ in the TPD and ALD groups, respectively. Complications included one case of surgical site infection in each group.

Similar outcomes of both approaches. TPD is quicker but may need hemi-laminotomy in the absence of liquid pus. ALD enables thick organized pus removal without compromising lamina in paradiscal-tuberculosis.