One-stage surgical management for thoracic tuberculosis by anterior debridement, decompression and autogenous rib grafts, and instrumentation

BACKGROUND CONTEXT: 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. PURPOSE: 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. STUDY DESIGN: A retrospective clinical study of one-stage surgical management for thoracic tuberculosis by anterior radical debridement, decompression and autogenous rib grafts, and instrumentation. PATIENT SAMPLE: Procedure was performed in 42 patients. OUTCOME MEASURES: 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 degrees on admission to an average of 3.7 degrees after surgery and to an average of 4.6 degrees at the final visit. No significant loss of deformity correction was noted in these patients. There was no other recurrence of the tuberculous infection. CONCLUSION: 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. (C) 2011 Elsevier Inc. All rights reserved.