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

English Keywords:Upper cervical spine  Transoropharyngeal  Posterior fixation and fusion  Tuberculosis

English Abstract:

  【Abstract】 Objectives: To investigate the effectiveness of anterior transoropharyngeal debridement combined with posterior fixation and fusion for upper cervical tuberculosis. Methods: From January 2003 to December 2013, 19 patients with upper cervical tuberculosis underwent the surgery of anterior transoropharyngeal debridement combined with posterior fixation and fusion in our hospital, there were 12 males and 7 females, with an average age of 41.9±8.3(6-71) years old. 11 cases had tuberculosis located in atlas with 6 atlantoaxial and 2 atlanto-occipital, all with atlanto-occipital joint or atlantoaxial lateral mass destructed severely, abscess was formed around lesion. JOA score, occipitocervical VAS score, ADI and fusion status were reviewed retrospectively. Results: 19 patients all accepted surgery successfully, 11 cases underwent occipitocervical fusion and fixation, 7 cases underwent atlantoaxial fusion and fixation and 1 case underwent C1-3 fusion and fixation. No spinal cord, nerve or blood vessel injury was noted during operation. All cases were followed up for an average of 33.2±7.2 months. Abscess was cleared completely and anatomical reduction was achieved in all cases according to X ray and CT scan. Bony fusion was achieved in 17 cases at 3 months later and the other 2 achieved bony fusion at 6 months later. Anti-TB drugs were used for an average of 16.9±1.3 months. All cases were clinical cured in 18 months after operation and no occurrence of nidus was found during follow-up. The JOA score increased from 7.9±1.1 preoperatively to 14.7±1.2 at final follow-up(P＜0.05), VAS of neck pain decreased from 6.5±0.4 preoperatively to 1.0±0.5 at final follow-up(P＜0.05), ADI decreased from 5.6±1.3mm preoperatively to 1.6±0.9mm at final follow-up(P＜0.05). No serious complications were noted during follow-up. Conclusions: Anterior transoropharyngeal debridement combined with posterior fixation and fusion is an effective treatment for upper cervical tuberculosis.