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Posterior Transforaminal Debridement and Fusion Without Costotransversectomy for Thoracic Pyogenic Vertebral Osteomyelitis
Sponsor: Xiangya Hospital of Central South University
Summary
This is a multicenter prospective randomized controlled trial comparing two posterior surgical approaches for thoracic pyogenic vertebral osteomyelitis (PVO). Eighty-nine patients from four hospitals were randomized 1:1 to either posterior transforaminal debridement and interbody fusion (PTDIF) with preservation of the posterior ligamentous complex, or posterolateral debridement and interbody fusion (PLDIF) which requires resection of the posterior ligamentous complex, proximal rib, and costotransverse joint. The primary outcomes included operative time, intraoperative blood loss, visual analog scale (VAS) pain scores, Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ASIA neurological grade, kyphosis correction, and complications. All 89 patients achieved complete recovery. PTDIF resulted in significantly less blood loss and shorter operative time compared to PLDIF, with comparable clinical and radiological outcomes.
Official title: Posterior Transforaminal Debridement and Fusion Without Costotransversectomy for Thoracic Pyogenic Vertebral Osteomyelitis: A Randomized Controlled Trial Emphasizing Posterior Ligamentous Complex Preservation
Key Details
Gender
All
Age Range
18 Years - Any
Study Type
INTERVENTIONAL
Enrollment
89
Start Date
2021-05-01
Completion Date
2023-08-31
Last Updated
2026-09-14
Healthy Volunteers
No
Conditions
Interventions
Posterior Transforaminal Debridement and Interbody Fusion (PTDIF)
Posterior-only surgical approach using a transforaminal/transpedicular corridor that preserves the posterior ligamentous complex, contralateral lamina, and facet joints, while avoiding costotransversectomy. The procedure includes unilateral partial laminectomy or hemilaminectomy, complete unilateral facetectomy, corpectomy, discectomy, abscess evacuation, and titanium mesh cage reconstruction with pedicle screw instrumentation.
Posterolateral Debridement and Interbody Fusion (PLDIF)
Posterolateral surgical approach involving resection of the spinous process, interspinous and supraspinous ligaments, 1-1.5 cm segment of the adjacent rib, and the costotransverse joint to create a wider lateral corridor. This is followed by unilateral hemilaminectomy and facetectomy, with subsequent debridement, fusion, and instrumentation identical to the PTDIF group.
Locations (4)
Changde First People's Hospital
Changde, Hunan, China
Changsha Central Hospital
Changsha, Hunan, China
Xiangya Boai Rehabilitation Hospital
Changsha, Hunan, China
Xiangya Hospital of Central South University
Changsha, Hunan, China