Clinical Research Directory

Posterior Transforaminal Debridement and Fusion Without Costotransversectomy for Thoracic Pyogenic Vertebral Osteomyelitis

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.