Selection of surgical treatment approaches for cervicothoracic spinal tuberculosis

English Keywords:Spinal tuberculosis  Cervicothoracic  Surgical approach

English Abstract:

  【Abstract】 Objectives: To explore the selection of surgical treatment according to the relation between the tuberculosis lesion segments and the suprasternal notch and the clinical outcomes for cervicothoracic spinal tuberculosis. Methods: From January 2003 to January 2013, 45 patients suffering from cervicothoracic spinal tuberculosis were treated surgically, among whom 29 were males and 16 were females, the average age was 35.4±16.7(range, 17 to 62) years. The pathologic change regions were as follows: C7-T1 in 8 cases, T1 in 11 cases, T1-T2 in 7 cases, T2 in 6 cases, T2-T3 in 8 cases and T3 in 5 cases. The presurgical neurological and functional classifications were class A for 2 case, B for 5 cases, C for 9 cases, D for 22 cases and E for 7 cases according to the American Spinal Injury Association(ASIA) system. According to the relation between tuberculosis lesion segments and suprasternal notch on sagittal MRI, 19 patients were treated with a single-stage anterior debridement, fusion and instrumentation approach, that the tuberculosis focus was located higher than the suprasternal notch level. The other 26 patients were treated with a single-stage anterior debridement and fusion, posterior fusion and instrumentation approach, that the tuberculosis focus lied right on the suprasternal notch level or lower than the suprasternal notch level. Quadruple sensitive anti-TB drug treatment was used in all 45 patients preoperatively and postoperatively. The clinical efficacy was evaluated by using statistical analysis based on the cervicothoracic angle of kyphosis, neck disability index(NDI) and Japanese Orthopedic Association(JOA) scoring system, which were 34.7°±6.8°, 39.6±4.6 and 10.7±2.8, preoperatively. Results: The mean surgical duration was 178.0±48.3 minutes. Intraoperative blood loss was averagely 590.0±76.4 milliliters. All patients were followed up for 6.6±3.2(3 to 13) years in average. No instrumentation loosening, migration or breakage was observed during the follow-up. The kyphosis angle, NDI and JOA scores were significantly changed to 10.2°±2.4°, 11.4±3.6 and 17.6±2.4 at last follow-up(P<0.05). One patient received single-stage anterior debridement, intervertebral fusion and internal fixation presented with a sinus of incision at 6-month follow-up. This particular patient then received one-stage anterior instrumentation removal, radical debridement and intervertebral fusion, second-stage posterior fusion and instrumentation. After a follow-up period of 5.5 years, the clinical cure of tuberculosis disease was observed. Bone fusion was achieved in the other 44 patients within 7.2±1.1 months. In 38 cases complicated with neurological disorders, 29(76%) showed 1 to 3 degrees of neurological functional recovery, and the left 9 patients showed no neurological functional changes. Conclusions: On the basis of regular anti-tuberculosis treatment, according to the anatomical relation of suprasternal notch and the cervicothoracic spinal tuberculosis diseased segments revealed on sagittal MRI images, different surgical approachs can achieve completely debridement, fixation and fusion. In that case, good clinical results will be obtained through medium and long term follow-up observation.