One-stage anterior debridement, titanium cage fusion with autograft and instrumentation for lower cervical spinal tuberculosis

English Keywords:Spinal tuberculosis  Lower cervical  One-stage anterior debridement  Titanium cage fusion with autograft  Instrumentation

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical efficacy of one-stage anterior debridement, titanium cage fusion with autograft and instrumentation for lower cervical spinal tuberculosis(TB). Methods: From December 2006 to July 2010, 10 patients suffering from lower cervical TB(6 males and 4 females, aged 42-71 years, mean age 52.1 years) underwent one-stage anterior debridement, titanium cage fusion with autograft and instrumentation. The defect sites were C3-C4 in 1 case, C4-C5 in 1 case, C5-C6 in 3 cases, C6-C7 in 2 cases, C5-C7 vertebrae in 3 cases. All patients had neck pain, fever, night sweats, 6 cases han limb sensory-motor dysfunction, the preoperative Frankel grade: 1 Frankel B, 2 Frankel C, 3 Frankel D, 4 Frankel E. 5 of them with cold abscess had no perforation to the posterior longitudinal ligament. The mean preoperative kyphosis angle was 19.1°±5.1°(ranged from 10° to 30°). Preoperative anti-TB treatment was given for at least 2 weeks, then the treatment lasted for 6-12 months postoperatively. Improvement of clinical symptoms and bone fusion were followed up. Results: The operations were successfully completed without injury of blood vessels, spinal cord, esophagus and trachea. The incision healed with no complications such as sinus formation and wound infection. The mean follow-up was 14.5 months ranged from 10 to 24 months. The patients′ clinical symptoms and the neurological dysfunction had different degrees of improvement, 5 cases combined with neurological deficits improved to Frankel E, 1 case improved from Frankel B to Frankel D. The kyphosis was corrected well. The average kyphosis angle of cervical spine was 2.9°±1.6° after 1 week of operation, which was significantly lower than preoperative one(P＜0.01); and 4.7°±2.3° at the final follow-up, which remained no change with 1 week postoperatively(P＞0.05). After 3-6 months postoperatively, all cases were showed signs of bone fusion. All cases were observed fully integrated titanium cage bone graft between the upper and lower vertebrae at the final follow-up, and no recurrence or instrument failure was noted. Conclusions: On the premise of standard anti-tuberculosis chemotherapy, one-stage anterior debridement, titanium cage fusion with autograft and instrumentation for lower cercical spinal tuberculosis is a safe and effective surgical method.