Surgical Treatment of Chronic Infectious Cervicothoracic Spondylitis

Background. Chronic infectious spondylitis of the cervicothoracic spine represents an etiologically heterogeneous group of diseases characterized by vertebral destruction within the C6–T3 region. There is no common strategy for the surgical treatment of this cohort of patients. The aim of the study was to analyze the technical features and long-term outcomes of surgical treatment for chronic infectious cervicothoracic spondylitis. Methods. The cohort included 18 patients treated between 2018 and 2022. Considering the etiology, long-term outcomes were analyzed in 11 patients with chronic nonspecific spondylitis and 7 patients with tuberculous spondylitis. Clinical, radiological, and surgical parameters were assessed. Long-term results were evaluated at 6 and 12 months postoperatively. Results. Chronic infectious spondylitis in the cohort was classified according to E. Pola (2017) as types B.3 (n = 10), C.2 (n = 4), C.3 (n = 1), and C.4 (n = 3). The mean age at the time of surgery was 48 years and 3 months (range 20–71). The groups were comparable in gender, age, and degree of local sagittal balance impairment. The etiology of chronic spondylitis influenced the extent of the destructive process (p = 0.009) and the severity of vertebrogenic pain syndrome (p = 0.028). Quality-of-life analysis revealed a greater degree of social maladaptation in tuberculous spondylitis group according to the NDI (p = 0.018) and SF-12 (p = 0.002) scales. Indications for various techniques of cervicothoracic reconstruction, including isolated ventral, isolated dorsal, and combined approaches, were determined. Conclusions. Chronic infectious spondylitis of the cervicothoracic spine is a rare and poorly studied pathology. The etiology of spondylitis affects the clinical course of the disease and the incidence of postoperative complications in the long term. Analysis of available data and evaluation of the authors’ experience allowed for the development of several tactical tools for planning surgical reconstruction, including an algorithm for selecting the surgical approach and determining the need for manubriotomy. Long-term surgical outcomes using the proposed tactical algorithm confirm its effectiveness and potential for further application.