Operative Treatment of Specific and Unspecific Spondylitis of the Thoracic Spine

Objective Prevention or cure of nerve root compression. Radical debridement and removal of inflammatory focus. Restitution of stability in the presence of radiologic evidence of vertebral body destruction. Restoration of profile of spinal column. Indications Spondylodiscitis complicated by neurologic deficits. Spondylitis with formation of abscess, progressive destruction of vertebral body and imminent instability. Contraindications Poor general health due to various illnesses. Surgical Technique Transthoracic approach to the spine (T2–T10). Transpleural retroperitoneal approach to the lumbar spine (T11–T12). Ligation of segmental vessels. Radical removal of inflamed tissue. Insertion of a MOSS® titanium cylinder filled with autogenous cancellous bone or rib according to Stolze & Harms. Additional anterior or posterior instrumentation to improve stability. Results Between October 1995 and November 2000, an anterior vertebral body replacement was performed in 19 patients (three women, 16 men, average age 63 [43–79] years) for spondylitis of the thoracic spine. In 14 of these patients, an additional anterior or posterior instrumentation was done. Follow-up after an average of 23 (7–66) months in 16 patients. Three patients passed away in the meantime. Neurologic status classified according to Frankel et al. Preoperative deficits found in 11/19 patients. At the time of follow-up, nine patients had improved by at least one grade. Since no scoring system for results of treatment for spondylitis could be found in the literature, we developed our own score that showed an improvement from 13 points preoperatively to 37 points postoperatively. Healing of spondylitis could be confirmed clinically and radiologically in all patients followed up.