Anterior debridement, autograft and internal fixation combined with postoperative local chemotherapy for lower cervical tuberculosis with huge abscesses

English Keywords:Spinal tuberculosis  Cervical vertebrae  Abscess  Debridement  Irrigation

English Abstract:

  【Abstract】 Objectives: To evaluate the efficiency of anterior debridement, autograft, internal fixation combined with postoperative irrigation, drainage and local chemotherapy with isoniazid for cervical tuberculosis with huge tuberculous abscesses. Methods: From June 2001 to June 2010, 13 inpatients(8 males and 5 females, aged 28-62 years, mean of 44 years) suffering from cervical tuberculosis with huge tuberculous abscesses were reviewed retrospectively. The vertebral tuberculosis sites included C3-C4 in two patients, C4-C5 in three patients, C5-C6 in four patients, C5 in two patients and C6 in two patients. Segments of the tuberculosis abscess were C3-C6 in five cases, C3-C7 in three cases, C4-C7 in four cases and C4-T1 in one case. All patients presented with neck pain and varying degrees of swallowing and breathing difficulties. The average neck visual analogue scales(VAS) score was 8.1±1.3(range, 7-10) preoperatively. 10 cases had neurological deficit, with the preoperative average JOA score of 8.3±1.7(range, 5-12). The preoperative ESR and CRP was 78±12mm/h and 65±17mm/h respectively. Under systemic and routine antituberculosis chemotherapy, all patients received anterior debridement, autograft and internal fixation. Postoperative persistent irrigation, drainage and local chemotherapy with isoniazid were performed. Systemic antituberculosis therapy continued for 12-18 months. The clinical symptoms, abscess clearance and bone fusion were followed up. Results: The operations were all successfully completed with no perioperative complications such as sinus, fistula and meningeal infection. Postoperative persistent irrigation, drainage and local chemotherapy lasted for 14 to 26 days(average, 18 days). The mean follow-up was 42 months(range, 24-72 months). The postoperative ESR and CRP returned to normal within three months in all patients. Bone fusion was achieved within 3-7 months(average, 5.8 months). Final follow-up VAS scores were from 0 to 3(average, 1.5±0.7) and were significantly lower than the preoperative ones(P<0.05). Final follow-up JOA scores were from 12 to 17(average, 14.6±1.5) and were significantly higher than the preoperative ones(P<0.05). There was no recurrence of tuberculosis under MRI at final follow-up. Conclusions: Under systemic and routine antituberculosis chemotherapy, anterior debridement, autograft, internal fixation combined with postoperative irrigation, drainage and local chemotherapy with isoniazid is effective and feasible for cervical tuberculosis with huge tuberculous abscesses.