Treatment for upper thoracic tuberculosis with anterior approach focal cleaning internal fixation by single nail-stick system,and bone graft

Objective To investigate the effects of surgical management for upper thoracic tuberculosis using focal cleaning,bone grafting and internal fixation through one side of anterior intrapleural approach.Methods 11 cases of upper thoracic tuberculosis were included in the study.The age ranged from 26 to 48 years with an average age of 32.3 years.Clinical features included thoracic and back pain and kyphosis.Kyphosis angle ranged from 14 to 45 degrees.5 cases were accompanied by spinal cord injury.According to ASIA score system,4 cases in C grade,and 1 case in D grade.The antituberculous treatment and nutritional supplement were also performed routinely during the perioperative period.Results During the follow-up period of an average 21 months.All of the cases were treated by primary debridement,decompression,bone graft and internal fixation of single nail-stick system.The operative time was from 2.5h to 5h and the mean operative time was 3 hours.The blood loss was from 500 ml to 1000 ml and the mean blood loss was 660 ml.The mean time in hospital was 10 days and the mean follow-up time was 18 months.The mean blood transfusion was 375 ml.During the follow-up period of an average 21 months.all cases healed without any recurrence and complications such as infection,respiratory failure and so on.The thoracic and back pain disappeared and erythrocyte sedimentation rate(ESR) decreased to a normal leve1.4 cases of neurological deficits were recovered within 4 weeks,and 1 cases of which recovered at 6 months after operation.Spinal fusion occurred after 3 to 8 months after operation,and seventeen degrees of kyphosis correction was achieved.Conclusion It is a safe and effective method to use focal cleaning,bone grafting and internal fixation through one side of anterior intrapleural approach in the management of upper thoracic tuberculosis.