Posterolateral Debridement and Anterior Reconstruction by Limited Spinal Shortening in Thoracic Spine Infections

Abstract

Background: Spinal infection is a very dangerous type of skeletal infection as it may be complicated with spin neurological deficit or spinal deformity, so early diagnosis and treatment is very important. Purpose: The aim of the current work was to evaluate the result of posterolateral debridement and anterior reconstruction by limited spinal shortening in thoracic spine infections. Patients and Methods: This retrospective clinical study included a total of 10 patients, 5 men and 5 women with thoracic spinal infection, attending at Sohag University Hospital. This study was conducted between 2003 and 2009. All patients were operated in the prone position through a single posterior midline exposure. Posterior stabilization by transpedicular screw fixation was performed. Medial 3 centimeters of 1 or 2 ribs were excised unilaterally. Anterior circumspinal dissection enables debridement of the lesion and evacuation of any abscess. Then, reconstruction of the anterior column was performed by limited spinal shortening followed by posterior fusion. Results: Causative organisms were TB in 8 patients, Staph aureus in 1 patient and bacteriologic testing of intraoperative samples did not find germs in 1 patient. Mean follow up was 90.3 months (range; 67- 150 months). No active infection occurred tell the end of follow up. Seven patients got neurological improvement. Two complications were encountered: kyphosis progression and temporary neurological deterioration. Conclusion: In cases of thoracic spinal infections, single posterolateral exposure is sufficient to debride the infected material, decompress the neural elements, and reconstruct the spine. Limited spinal shortening allows anterior reconstruction without the need for bone grafting.