In severe osteomyelitis of the spine, open debridement and anterior fusion by anterior bone grafting offers the advantage of eradication of the focus of infection and improvement of conditions for bony fusion of the affected vertebral bodies. Some limited papers reported the use of spinal shortening for anterior reconstruction after fractures or tumors. Ten patients of infections of the thoracic spine were treated surgically at Sohag University Hospital, Sohag, Egypt by single posterolateral exposure. Age of the patients ranged between 35 and 71 years with a mean age of 56.5 years. All patients were operated in the prone position through a single posterior exposure. Posterior stabilization by trans-pedicular screw fixation was performed. Anterior dissection enables debridment of the lesion and evacuation of any abscess. Then, reconstruction of the anterior column was performed by limited spinal shortening followed by posterior fusion. Causative organisms were TB in 8 patients, Staph aureus in 1 patient and bacteriologic testing of intraoperative samples did not find germs in 1 patient. Mean follow up was 30.7 months (range; 5- 80 months). No active infection occurred tell the end of follow up. Seven  patients got neurological improvement. Two complications were encountered; kyphosis progression and temporary neurological deterioration.

In conclusion, in cases of thoracic spinal infections, single posterolateral exposure is sufficient to debride the infected material, decompress the neural elements, and reconstruct the spine. Limited spinal shortening allows anterior reconstruction without the need for bone grafting.