Anterior retropharyngeal debridement combined with posterior fixation and fusion for upper cervical tuberculosis

English Keywords:Upper cervical spine  Atlantoaxial  Occipital-cervical fusion  Tuberculosis

English Abstract:

  【Abstract】 Objectives: To investigate the effectiveness of anterior retropharyngeal debridement combined with posterior occipitocervical fusion and fixation for upper cervical spinal tuberculosis. Methods: From January 2002 to June 2012, 21 patients with upper cervical tuberculosis underwent surgery in our hospital, 11 cases with atlantooccipital, lateral mass and atlantoaxial joint destructed severely were selected in this study. 7 of 11 cases were males, and 4 were females, the average age was 40.4±9.5 years(range, 26 to 54 years). 4 cases had tuberculosis in atlas and 7 in atlantoaxial. All cases underwent anterior retropharyngeal debridement combined with posterior fixation and fusion. According to the degree of pedicle destruction, bilateral pedicle screw fixation was performed in 2 cases, bilateral laminar screw in 3 cases and l hybrid fixation in 6 cases. Postoperative anti-TB drugs were used for 18 months, and JOA score, occipitocervical VAS score, fusion status, reduction degree and complications were reviewed retrospectively. Results: 11 patients were followed up for 39.5±13.1 months. Anatomical reduction was achieved in 9 cases, partially reduction in 2 cases, bony fusion was achieved in 10 cases 4 months later, and the other one achieved bony fusion at 6 months due to partially absorption of graft. All cases were clinical cured in 18 months after operation. The JOA score increased from 8.4±1.3 preoperatively to 15.0±1.3 at final follow-up(P＜0.05), VAS of neck pain decreased from 6.7±0.6 preoperatively to 0.6±0.6 at final follow-up(P＜0.05). No serious complications were noted during follow-up. Conclusions: The anterior retropharyngeal debridement combined with posterior fusion is an effective treatment for upper cervical tuberculosis.