Posterior approach combined with thoracic intervertebral foramen posterior wall opening and spinal reconstruction for complex thoracic intervertebral foramen lesions: a single-centre experience
Background: Thoracic intervertebral foramen (TIF) lesions were really difficult to expose through posterior or transforaminal approaches. There was no effective treatment strategy, especially for complex ones.
Methods: Between 2013 and 2015, 22 patients presenting with complex TIF lesions underwent posterior approach combined with TIF posterior wall opening and spinal reconstruction were retrospectively reviewed. After ascertaining the precise location of complex TIF lesions, incisions should allow for exposure of the lesion’s adjacent vertebral pedicle screw entry point. The adjacent pair of vertebral lamina and spinous processes are typically removed in a single piece, such that the intra-spinal section can be fully exposed. The posterior wall of the TIF is subsequently opened, allowing the intra-TIF and extra-spinal sections to be sufficiently exposed. Subsequently, spinal reconstruction at the appropriate level is required. When the ventral spinal column is intact, dorsal reconstruction is typically performed using the screw and rod fixation technique (SRFT). After the dorsal surface of the spine has been burnished, the removed vertebral lamina and spinous process are rendered granular to allow reconstruction of the TIF and fusion of adjacent vertebrae.
Results: All patients presenting with complex TIF lesions were successfully treated with this approach. No patient had experienced any complications arising from SRFT use. No patient suffered intraspinal infection, incision splits, or CSF leakage in the short-term (between 1 and 3 months) or fixation loosening or spinal instability in the long-term (6–24 months). Imaging studies confirmed that the TIF and spinal reconstruction outcomes were favorable.
Conclusions: A posterior approach combined with TIF posterior wall opening and spinal reconstruction is a rapid, effective, and reliable method in the treatment of complex TIF lesions. This technique can provide total lesion resection while reconstructing spinal stability.
Keywords: posterior approach; thoracic intervertebral foramen (TIF); intervertebral articular process (IAP); spinal reconstruction; screw and rod fixation technique (SRFT)