Posterolateral bilateral extrapleural approach in surgical treatment of nonspecific spondylitis of the upper thoracic spine: a retrospective analysis of 12 cases

Purpose. Evaluation of the effectiveness and safety of posterolateral bilateral extrapleural access in the surgical treatment of nonspecific spondylitis of the upper thoracic spine.

Methods. The study included 12 patients with nonspecific purulent pathology of the upper thoracic spine, who were operated on with the use of posterolateral bilateral extrapleural approach. In 10 cases, in addition to pain syndrome, the clinical picture of the disease was represented by conduction symptoms, including isolated pain in 2 cases. Localization of the pathological process at Th3-Th4 vertebrae occurred in 3 patients, at the Th4-Th5 – in 5, and at the Th5-Th6 – in 4 patients.

Results. In all patients, a decrease in the intensity of pain by 5-7 points (6,2 on average) on the visual analog scale (VAS) was noted in the postoperative period. During the observation period, regression of conduction disorders was observed in 2 patients, complete recovery was observed in 5 (Frankel E). The results of the control examination revealed the suppression of the inflammatory process and complete bone consolidation in all cases (Grade I-II according to Eck et al). The duration of the operations varied from 240 to 375 min. (on average – 307 min). The volume of blood loss ranged from 300 to 1200 ml. (on average – 658 ml). Intraoperative liquorrhea was observed in 2 cases.

Conclusion. Posterolateral bilateral extrapleural access allows for radical sanitation, complete decompression and spinal fusion for nonspecific purulent lesions of the upper thoracic spine. Moving away from a standard technique by Capener N. and Larson S.J. allowed to significantly expand access options and minimize the risk of complications. Despite the complexity, duration and large volume of blood loss, the use of this method is justified for nonspecific spondylitis of the upper thoracic localization. However, at other levels, if there is an alternative in the form of ventral interventions, its use might be irrational.

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