title: One-stage surgical management for thoracic tuberculosis by anterior debridement, decompression and autogenous rib grafts, and instrumentation.
abstract: BACKGROUND
  Patients with thoracic tuberculosis have been not always successfully treated by radical debridement and bone grafting with or without supplementary posterior instrumentation and fusion, although most surgeons use posterior instrumentation to support anterior strut grafts.
  
  
  OBJECTIVE
  To determine the efficacy of anterior instrumentation after radical debridement and autogenous rib grafts in patients with thoracic tuberculosis over a 6-year period at a single institution.
  
  
  METHODS
  A retrospective clinical study of one-stage surgical management for thoracic tuberculosis by anterior radical debridement, decompression and autogenous rib grafts, and instrumentation.
  
  
  METHODS
  Procedure was performed in 42 patients.
  
  
  METHODS
  Kyphotic angle was measured to assess the severity of the thoracic tuberculosis. Neurologic outcome was evaluated using Frankel grade, infection activity using erythrocyte sedimentation rate value and C-reactive protein value, and pain using a visual analog scale pain score.
  
  
  METHODS
  In this retrospective study, the authors evaluated 42 patients (25 men and 17 women; average age, 47.7 years) with thoracic tuberculosis, who underwent one-stage anterior radical debridement, decompression and autogenous rib grafts, and instrumentation. The average follow-up period was 50.8 months (range, 24-85 months).
  
  
  RESULTS
  A solid fusion was achieved in all cases. Of all 42 patients with preoperative kyphosis, the deformity was corrected from an average of 19.8° on admission to an average of 3.7° after surgery and to an average of 4.6° at the final visit. No significant loss of deformity correction was noted in these patients. There was no other recurrence of the tuberculous infection.
  
  
  CONCLUSIONS
  The authors think that the one-stage anterior autogenous rib grafts and instrumentation are safe and effective methods in the surgical management of thoracic tuberculosis.
authors.affiliation: Department of Orthopaedic Surgery, Xijing Hospital, the Fourth Military Medical University, 127 West Changle Rd, Xi'an, Shaanxi Province 710032, China.
authors.forename: Mo
authors.initials: M
authors.lastname: Li
authors.forename: Junjie
authors.initials: J
authors.lastname: Du
authors.forename: Hao
authors.initials: H
authors.lastname: Meng
authors.forename: Zhe
authors.initials: Z
authors.lastname: Wang
authors.forename: Zhuojing
authors.initials: Z
authors.lastname: Luo
mesh_terms: D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods*; D003646:Debridement / Q000379:methods*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D012272:Ribs / Q000637:transplantation*; D013123:Spinal Fusion / Q000379:methods*; D013904:Thoracic Vertebrae; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000601:surgery*; D055815:Young Adult