Anterolateral versus Transpedicular Decompression with Posterior Instrumentation: A Randomized Prospective Study in Paradiscal Thoracic Spine Tuberculosis

Introduction: Surgical decompression is necessary for anterior paradiscal-type thoracic spine tuberculosis with a neurological deficit; nevertheless, if pedicle screw fixation is unsuccessful, laminectomy may result in pan-vertebral instability. No available studies compare traditional anterolateral decompression (ALD) with the convenient, less extensive technique of transpedicular decompression (TPD). Methods: This randomized comparative study of 20 cases of thoracic spine tuberculosis (T2-T12) used a posterior midline surgical approach with pedicle screw instrumentation. Diseased pedicle removal by eggshell technique (TPD) was compared with decompression by removal of the posterior part of the rib, transverse process, pedicle, and posterolateral part of the diseased vertebral body (ALD). Results: in the TPD and ALD groups, respectively. Complications included one case of surgical site infection in each group. Conclusions: Similar outcomes of both approaches. TPD is quicker but may need hemi-laminotomy in the absence of liquid pus. ALD enables thick organized pus removal without compromising lamina in paradiscal-tuberculosis.