Mao Ningfang, Shi Zhicai, Ni Haijian, Zhao Yingchuan, Tang Hao, Liu Deding, Zhu Xiaodong, Bai Yushu, Li Ming
Department of Orthopaedics, Changhai Hospital, Second Military Medical University, Shanghai, China.
Br J Neurosurg. 2013 Apr;27(2):160-6. doi: 10.3109/02688697.2012.722706. Epub 2012 Sep 17.
Patients with spinal deformities and nerve compression due to spinal tuberculosis often require surgical intervention. The objective of this study was to assess the long-term therapeutic effectiveness of one-stage anterior debridement, bone grafting, and internal fixation for lower cervical tuberculosis with kyphosis.
Twenty-one patients with lower cervical tuberculosis and cervical kyphosis received one-stage anterior debridement, autologous iliac bone grafting, and internal plate fixation. Patients were followed-up postoperatively for at least 5 years. Outcome measures included neck pain using Visual Analogue Scale (VAS) scores, Frankel classification of spinal cord injury, and Cobb angle of cervical kyphosis.
Eighteen patients had lesions in 2 vertebrae and 3 had lesions in 3 vertebrae. Cervical tuberculosis was cured in all patients. The mean preoperative VAS score for neck pain was 8 (range: 6-10), whereas the mean best postoperative VAS score was 0.6 (range: 0-3). Mean final VAS score was significantly higher than the best VAS score (2.14 vs. 0.62). Of the 13 patients with symptoms of spinal cord compression, 9 improved by 1 grade and 4 improved by 2 grades according to Frankel classification at final follow-up. The mean preoperative Cobb angle of cervical kyphosis was 29° (range: 15°-50°), whereas the mean postoperative Cobb angle at final follow-up was -1.8° (range: 2-7°).
One-stage anterior debridement, bone grafting, and internal fixation can effectively remove lesions, decompress the nerve, reduce pain, and correct kyphosis in patients with cervical tuberculosis and associated kyphosis. Long-term postoperative outcomes were satisfactory.
因脊柱结核导致脊柱畸形和神经受压的患者通常需要手术干预。本研究的目的是评估一期前路清创、植骨和内固定治疗下颈椎结核伴后凸畸形的长期治疗效果。
21例下颈椎结核伴颈椎后凸畸形患者接受了一期前路清创、自体髂骨植骨和钢板内固定。术后对患者进行至少5年的随访。观察指标包括采用视觉模拟评分法（VAS）评估颈部疼痛、脊髓损伤的Frankel分级以及颈椎后凸的Cobb角。
18例患者病变累及2个椎体，3例患者病变累及3个椎体。所有患者的颈椎结核均治愈。术前颈部疼痛的平均VAS评分为8分（范围：6 - 10分），而术后最佳平均VAS评分为0.6分（范围：0 - 3分）。最终平均VAS评分显著高于最佳VAS评分（2.14对0.62）。在13例有脊髓受压症状的患者中，末次随访时根据Frankel分级，9例改善1级，4例改善2级。术前颈椎后凸的平均Cobb角为29°（范围：15° - 50°），而末次随访时术后平均Cobb角为 - 1.8°（范围：2 - 7°）。
一期前路清创、植骨和内固定可有效清除病灶、解除神经压迫、减轻疼痛并矫正颈椎结核伴后凸畸形患者的后凸畸形。术后长期效果满意。
