He Maolin, Xu Hua, Zhao Jinmin, Wang Zhe
Division of Spinal Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Rd, Nanning, Guangxi 530021, China.
Center for Education Evaluation and Faculty Development, Guangxi Medical University, No. 22 Shuangyong Rd, Nanning, Guangxi 530021, China.
Spine J. 2014 Apr;14(4):619-27. doi: 10.1016/j.spinee.2013.06.076. Epub 2013 Dec 4.
Cervical spine tuberculosis (TB) is uncommon, accounting for 3% to 5% of spinal TB. Although the development of anti-TB chemotherapy decreases the mortality rate significantly, it may not be applicable for all situations, especially for those with risk of instability, progression of neurologic deficit, and failure of medical treatment.
To evaluate the efficacy of anterior instrumentation after debridement and bone grafting in patients with lower cervical TB over a 5-year period at a single institution.
A retrospective study examining the results of anterior debridement, decompression, bone grafting, and instrumentation for lower cervical spine TB.
The procedure was performed in 25 patients.
The clinical outcomes of infection activity, deformity, pain, and neurologic function were evaluated using erythrocyte sedimentation rate value and C-reactive protein value, kyphotic angle, visual analog scale pain score, and Frankel grade, respectively.
Between 2005 and 2010, 25 patients (18 males and seven females; average age, 39 years) with lower cervical spine tuberculosis (C3-C7) underwent anterior debridement, decompression, bone grafting, and instrumentation. The average follow-up period was 37.4 months (range 24-57 months). The medical records and radiographic findings of the patients were reviewed.
There were three patients who had involvement of one vertebra, 18 had two vertebrae of involvement, and four had three vertebrae of involvement. Before surgery, there were three patients with Frankel grade B, five with grade C, 12 with grade D, and five with grade E. During the last follow-up examination, in 20 patients with neurological deficit, 11 patients improved one grade, six patients improved two grades, one patient improved three grades, and the neurologic status remained unchanged in two patients. Stable bone union was observed in all cases and the average time required for fusion was 6.8 months. The kyphosis Cobb angle improved from the preoperative average of 15.48° (range 0°-55°) to a postoperative average of -4.8° (range -12° to 4°) and there was no significant correction loss during the follow-up period. During the follow-up period, there were no grafts or instrumentation-related stabilization problems. There was no other recurrence of TB infection.
Anterior debridement, decompression, bone grafting, and instrumentation are safe and effective methods in the surgical management of lower cervical spine tuberculosis.
颈椎结核并不常见，占脊柱结核的3%至5%。尽管抗结核化疗的发展显著降低了死亡率，但它可能并不适用于所有情况，尤其是对于那些有不稳定风险、神经功能缺损进展以及药物治疗失败的患者。
评估在单一机构对下颈椎结核患者进行清创、植骨后前路内固定的5年疗效。
一项回顾性研究，考察下颈椎结核前路清创、减压、植骨及内固定的结果。
该手术共对25例患者实施。
分别使用红细胞沉降率值和C反应蛋白值、后凸角、视觉模拟评分疼痛评分以及Frankel分级评估感染活动、畸形、疼痛和神经功能的临床结果。
2005年至2010年间，25例下颈椎结核（C3 - C7）患者（18例男性，7例女性；平均年龄39岁）接受了前路清创、减压、植骨及内固定。平均随访期为37.4个月（范围24 - 57个月）。对患者的病历和影像学检查结果进行了回顾。
累及一个椎体的患者有3例，累及两个椎体的有18例，累及三个椎体的有4例。术前，Frankel分级为B级的患者有3例，C级5例，D级12例，E级5例。在最后一次随访检查时，20例有神经功能缺损的患者中，11例改善了一个等级，6例改善了两个等级，1例改善了三个等级，2例神经状态未改变所有病例均观察到稳定的骨愈合，融合平均所需时间为6.8个月。后凸Cobb角从术前平均15.48°（范围0° - 55°）改善到术后平均 - 4.8°（范围 - 12°至4°），随访期间无明显矫正丢失。随访期间未出现与植骨或内固定相关的稳定问题。未发生其他结核感染复发情况。
前路清创、减压、植骨及内固定是下颈椎结核手术治疗的安全有效方法。
