title: One-stage surgical management for multilevel tuberculous spondylitis of the upper thoracic region by anterior decompression, strut autografting, posterior instrumentation, and fusion.
abstract: METHODS
  A retrospective clinical study of 1-stage surgical management for multilevel tuberculous spondylitis of the upper thoracic region (MTSUTR).
  
  
  OBJECTIVE
  MTSUTR has rarely been documented in the literature. We present a retrospective clinical study of 23 patients with MTSUTR treated by anterior decompression, strut autografting, posterior instrumentation, and fusion. The purpose was to determine the clinical efficacy of such surgical treatment for MTSUTR.
  
  
  BACKGROUND
  It is considered safe and effective to treat surgically tuberculous spondylitis with local spinal cord compression. Many reports have documented a good clinical efficacy of surgical management for spinal tuberculosis. However, how to deal with MTSUTR is rarely reported in the literature.
  
  
  METHODS
  There were 14 men and 9 women, with average age of 35 years. All patients underwent 1 stage anterior debridement, strut autografting, and posterior instrumentation and received combined medication antituberculosis chemotherapy for 12 to 24 months (average 18 mo). The following data were followed up for an average period of 42 months (24 to 60 mo) in these patients: deformity angle, neurologic function, and spinal bony fusion.
  
  
  RESULTS
  The average preoperative deformity angle was 44 degrees, correcting to 20-degree postoperatively and 24 degrees at final follow up. In the series, 19 patients with preoperative neurologic deficit restored by 1.3 grades according to Frankel. All patients got bony spinal fusion within 6 months postoperatively. There was no recurrent tuberculous infection.
  
  
  CONCLUSIONS
  Single-stage anterior debridement, strut autografting, posterior instrumentation, and fusion proved safe and effective for MTSUTR, which can achieve goals of complete spinal cord decompression and good deformity correction.
authors.affiliation: Department of Spine Surgery, Xiangya Hospital of Central-South University, Changsha, China. zhq9996@163.com
authors.forename: Hong-Qi
authors.initials: HQ
authors.lastname: Zhang
authors.forename: Chao-Feng
authors.initials: CF
authors.lastname: Guo
authors.forename: Xun-Gang
authors.initials: XG
authors.lastname: Xiao
authors.forename: Wen-Rong
authors.initials: WR
authors.lastname: Long
authors.forename: Zhan-Sheng
authors.initials: ZS
authors.lastname: Deng
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D003646:Debridement; D019299:Decompression, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012272:Ribs / Q000637:transplantation*; D013123:Spinal Fusion; D013904:Thoracic Vertebrae; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000601:surgery*