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Anterior Column Reconstruction with Bundled Autologous Rib Graft after Thoracic Spinal Tuberculosis Debridement

Introduction Vertebral defects are created after radical debridement for spinal tuberculosis, which often require anterior spinal column reconstruction with a strut graft. Autologous rib can be harvested through the same skin incision and can be exploited to reconstruct anterior column defect for thoracic spinal tuberculosis. The purpose of this study was to assess the clinical efficacy of bundled autogenous rib graft for anterior column reconstruction after thoracic spinal tuberculosis debridement. Material and Methods Fifty-eight patients with a confirmed diagnosis of thoracic vertebral tuberculosis (T4-T11) between January 2008 and December 2013 were analyzed retrospectively. All patients underwent anterior radical debridement and immediate reconstruction using bundled autologous rib with anterior instrumentation. We retrospectively analyze the clinical and radiographic data. Results All patients were followed 24–42 months and achieved solid bony fusions. There was no slide, subsidence, migration and breakage of bundled autogenous rib and screw-rod system. No significant loss of deformity correction was noted. Spinal cord function was effectively improved in all patients who had incomplete paralysis before surgery. There was no recurrence of tuberculosis. Pleural damage occurred in 10 ases while the rib was harvested. They were treated successfully with repair and closed drainage after operation. Two patients suffered from intercostal neuralgia postoperative and were relieved using non-steroidal anti-inflammatory (NSAID). The length of the rib harvested intraoperative was 15–22 cm with an average of 17.1 cm. Length of bundled autologous rib was 1.5–4.6 cm with an average of 3.7 cm. Cross-sectional area of bundled autologous rib accounted for an average of 35% of the endplate area adjacently. Conclusions This case series demonstrates anterior radical debridement, graft and instrumentation are safe and effective methods for thoracic tuberculosis. The bundled autogenous rib graft and anterior instrumentation could work effectively to provide immediate stabilization for reconstruction of anterior column defect created by radical debridement for thoracic spine.