Posterior Extensive Circumferential Decompressive Reconstructive Technique in Surgical Treatment of Upper Thoracic Spine Compressive Lesions Khaled Omran and Ahmed S. Abdel-Fattah - BACKGROUND: Complexity in ventral surgical exposure and presence of scapula and large parascapular muscu- lature during posterior surgery are the main obstacles in operative treatment of upper thoracic spine compressive lesions (UTSCLs), such as trauma, tuberculosis, and neoplasm. Recently, the advantages of combined ven- trodorsal surgery could be successfully gained using a 1-stage posterior salvage technique with enough acces- sibility to all 3 spinal columns. This was a retrospective evaluation of 35 patients with UTSCLs treated by the posterior extensive circumferential decompressive recon- structive (PECDR) procedure. - METHODS: Traumatic, tuberculosis, and neoplastic lesions were involved between 2009 and 2012. All patients were examined pre- and postoperatively and during follow-up clinically (pain by visual analog scale), neuro- logically (sensory and motor deficit by American Spinal Injury Association grading), functionally (Oswestry Disability Index), radiologically (kyphosis correction, loss of correction, and fusion time), and with laboratory investigations in patients with tuberculosis. Two authors plus an independent observer performed the final clinical, neurologic, and radiologic examination. Operative time, hospital stay, blood loss, and complications were documented. - RESULTS: The mean follow-up period was 36  5.5 months. Local symptoms, deformity correction, and neuro- logic recovery significantly improved postoperatively. Solid fusion was evident in 32 cases. No major complications were reported. Three patients developed wound infection and 3 had intercostal neuralgia; both complications were resolved uneventfully and did not influence the outcomes. - CONCLUSIONS: Because of difficult ventral exposure, the PECDR technique is a feasible tool for maintained deformity correction, bony fusion, thecal decompression, and functional improvement in surgical treatment of UTSCLs. However, tuberculosis had better satisfactory results than traumatic and neoplastic lesions. INTRODUCTION T raumatic, infectious, and neoplastic compressive lesions may affect the upper thoracic spine (T1-5) region with or without kyphotic deformity. 1,2 A narrow thoracic inlet, the proximity of the brachial plexus, a supra-aortic trunk, large parascapular musculature, and the transition from mobile cervical lordosis to rigid thoracic kyphosis are the main causes of complexity and difficulty in anterior or posterior approaching of the upper thoracic segments. 3,4 We discuss our experience with the posterior extensive circumferential decompressive recon- structive (PECDR) technique with clinical, laboratory, functional, and radiologic evaluations in 35 patients with upper thoracic spine compressive lesions (UTSCLs). PATIENTS AND METHODS During 4-year intervals between January 2009 and December 2012, 35 patients (20 men [57.1%] and 15 women [42.9%]) with UTSCLs Key words - PECDR - Posterior extensive circumferential decompressive reconstructive - UTSCL - Upper thoracic spine compressive lesions Abbreviations and Acronyms ASIA: American Spinal Injury Association EBL: Estimated blood loss FPMMA: Fashioned poly (methyl methacrylate) MDCT : Multidetector computed tomography ODI: Oswestry Disability Index PECDR: Posterior extensive circumferential decompressive reconstructive SCC: Spinal canal compromise TB: Tuberculosis UTSCL: Upper thoracic spine compressive lesion VAS: Visual analog scale Department of Orthopedic Surgery and Traumatology, Minia University Hospital, El-Minia; and Minia University Spine Unit, Faculty of Medicine, Minia University, Minia University Hospital, El-Minia, Egypt To whom correspondence should be addressed: Khaled Omran, M.D. [E-mail: khaled.omran@mu.edu.eg] Citation: World Neurosurg. (2019). https://doi.org/10.1016/j.wneu.2018.11.194 Journal homepage: www.journals.elsevier.com/world-neurosurgery Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2018 Elsevier Inc. All rights reserved. WORLD NEUROSURGERY -: e1-e8, - 2019 www.journals.elsevier.com/world-neurosurgery e1 Original Article