Treatment of tuberculous spondylitis at the cervicothoracic junction. Clinical impact of surgery by means of a sternotomy

Abstract

The operative treatment of tuberculous spondylitis remains a challenge with regard to the surgical approach to the cervicothoracic junction. In addition, it is difficult to restore the resected vertebral bodies. Two cases of tuberculous spondylitis in this area are presented. The first case concerns a 25-year-old African patient suffering from the effects of tuberculous spondylitis: Destruction of vertebral bodies dorsal (D)1, D2, and D3, kyphosis coupled with compression of the spinal cord, as well as incomplete motor and sensory paraplegia (Frankel grade C). The operative treatment of tuberculous spondylitis that is described, approached the cervicothoracic junction by means of a sternotomia. Corpectomy of vertebral bodies D1 through D3 were followed by their restoration with the help of a titanium cage. As a result, the paraplegia disappeared. Ventral decompression was followed by dorsal instrumentation. The results of the operation are decompression of the spinal cord, correction of the kyphosis, and stable fusion followed by restitution of the paraplegia. Primary stability was provided by the use of a titanium cage and dorsal instrumentation. There was no need for an external brace. There was no loss of correction 3 years after the operation. The 2nd case concerns a 49-year-old European patient suffering from thoracic pain radiating around the chest. A partial destruction of D2 and D3 with kyphosis and compression of the spinal cord because of a tuberculous spondylitis were detected, neurological deficits were not found. The corpectomy of D2 and D3 were proceeded by means of a sternotomy, the defect was restored with the help of a titanium cage. Due to the use of a ventral Morscher plate an additional dorsal instrumentation was not necessary. The patient was fixed in a minerva plaster for 3 months. There was no loss of correction 2 years after the operation. Both patients are manual workers and postoperatively adapted to their former work.