Evaluation of the effectiveness of single posterior only approach for circumferential decompression of thoraco-lumbar thecal sac and anterior column reconstruction with posterior stabilization

Abstract

Background: The common indications for spinal decompression surgeries performed in India are infections, fractures and tumors. Our study objective is to evaluate the effectiveness of 360 degree circumferential decompression of thoracolumbar thecal sac through single midline posterior approach and anterior column reconstruction with posterior stabilization. Materials & methods: A prospective study of 31 patients with 24 patients having neurological deficit was conducted among the trauma, infection and tumor patients attending the outpatient and inpatient department of Orthopedics at Gitam Institute of Medical Sciences and Research from 2017 to 2020 with a minimum follow up of 6 months. They were followed up on monthly basis till satisfactory fusion was seen on X-ray and every 6 months thereafter till 2 years. Clinical evaluation is done using ASIA motor score, ASIA impairment scale and VAS score. Radiological union and correction of deformity will be assessed using anteroposterior and lateral radiographs using kyphotic angle, graft fusion and implant status. Results: Neurological recovery occurred in 91.7% patients and all the patients neurology was either stable or improved post operatively. The mean post operative ASIA motor score was 91.36±13.71 (p-value<0.001). The mean post operative kyphotic angle was 10.55±8.25 (p-value<0.001), there was no loss of kyphosis correction on follow up. The mean post operative VAS was 2.32±0.75 (p-value<0.001). No intra operative or post operative complications were encountered. There was no implant related complication seen during the study. Conclusion: The posterior transpedicular approach provides sufficient access for safe and effective circumferential decompression and three column stabilization. The technique achieved a high success rate for pain relief, neurological preservation and functional improvement. Less intra operative blood loss, complications, shorter operative time, better pulmonary function after operation and early rehabilitation are significant advantages of posterior alone surgery compared with combined anterior and posterior approaches.