Surgical treatment of upper cervical tuberculosis with different approaches and its efficacy evaluation

English Keywords:Upper cervical  Tuberculosis  Surgical treatment  Curative effect

English Abstract:

  【Abstract】 Objectives: To investigate different approaches in the surgical treatment of upper cervical spine tuberculosis and their clinical efficacy. Methods: The clinical data of 39 patients(17 males and 22 females, aged 3-70 years) with upper cervical tuberculosis who underwent surgery in our hospital from January 2015 to December 2020 were retrospectively analyzed. Among them, 10 cases were accompanied by dysphagia, 24 cases had numbness, pain, and weakness of both upper limbs, and 11 cases had weakness of lower limbs and unstable walking. Standard anti-tuberculosis drug therapy was given 2 to 4 weeks before surgery. 12 patients were treated with simple anterior surgery; 8 patients were treated with simple posterior surgery; 19 patients were treated with combined posterior and anterior surgery. The Japanese Orthopaedic Association(JOA) cervical function score, occipitocervical visual analog scale(VAS), American Spinal Injury Association(ASIA) spinal cord injury grade and complications were recorded before and after operation and at the final follow-up in all patients. Results: All 39 patients completed the operation, no spinal cord, nerve root, vertebral artery and other injuries occurred during the operation, and the postoperative pathological examination was diagnosed as tuberculosis. All patients were followed up for 12-30 months with an average of 15.5±4.1 months. Among them, the JOA scores in the simple anterior group were 11.1±1.9, 13.8±1.3 and 15.6±1.3 before surgery, after surgery and at final follow-up respectively, and the VAS scores were 6.8±0.8, 3.3±1.0 and 2.1±1.2; JOA scores in the simple posterior group were 12.9±2.2, 14.9±1.8 and 15.9±1.2, and VAS scores were 7.1±0.6, 3.6±0.7 and 2.3±1.2; the JOA scores of the posterior-anterior combined group were 10.0±2.0, 12.7±1.4 and 14.4±1.1, and the VAS scores were 6.5±1.0, 3.5±1.0 and 2.2±1.0. The postoperative and final follow-up scores of the simple anterior group and posterior-anterior combined group were significantly improved compared with those before operation(P<0.01), and the final follow-up scores were also significantly improved compared with postoperative ones(P<0.01); the final follow-up JOA score of the simple posterior group was significantly improved than before operation(P<0.01), the postoperative and final follow-up VAS score of the simple posterior group was significantly improved before the operation(P<0.01). 1 patient in the posterior-anterior combined group was found with a sinus in the posterior cervical operation area, and indexes such as erythrocyte sedimentation rate increased at 3 months follow up after operation. After debridement, dressing change, adjustment of anti-tuberculosis drugs, and extension of wearing a neck brace for 1 month, the wound healed. The remaining patients experienced no complications at the final follow-up. Among the patients in the simple anterior group, 2 cases were of ASIA grade C and 5 cases were of grade D, and 1 patient was improved from grade C to grade D at the final follow-up, and the rest recovered to grade E. Among the patients in the simple posterior group, 1 case were of ASIA grade C and 1 case were of grade D, and they recovered to grade E at the final follow-up. Among the patients in the combined posterior- anterior group, 2 cases were of ASIA grade B, 6 cases were of grade C, and 7 cases were of grade D. At final follow-up, 1 improved from grade B to C only, 1 improved from grade B to D, 2 improved from grade C to D, and the rest recovered to grade E. At final follow-up, all 39 cases reached the standard of cure. Conclusions: The surgical treatment of upper cervical tuberculosis should be based on the clinical symptoms, characteristics of tuberculosis lesions, and neurological function, and individualized surgical approaches of simple anterior, posterior or combined posterior-anterior surgery accordingly can achieve satisfactory clinical effects.