Bunmaprasert Torphong, Dongsang Kittipong
J Med Assoc Thai. 2015 Jan;98(1):33-8.
Cervical involvement in spinal tuberculosis is rare; however delayed diagnosis and treatment may result in massive, irreversible neurological deterioration. The purpose of this study is to report on a strategy for clinical diagnosis and management of cervical spinal tuberculosis.
Eighteen patients (13 males and 5 females) during 1998-2013 were retrospectively reviewed at Chiang Mai University Hospital. The patients had a mean age of 51.4 years (range 37-68 years). History, examination, radiographs, MRI and tissue sampling were used in diagnosis. Most of the patients were given antituberculous therapy (ATT) and underwent surgical management. The mean follow-up period was 12.8 months.
Axial neckpain, quadriparesis, spastic gait and hand clumsiness were the predominant symptoms. Disc narrowing, endplate destruction andparaspinal soft tissue swelling were the prominent radiographic findings. MRI found Gadolinium enhancement of prevertebral soft tissue, T2 hypersignal of the intervertebral discs, intraosseous T2 hypersignal at the vertebral body, and disc fragmentation. Thirteen patients underwent single-stage anterior debridement with fusion. Three patients underwent posterior fusion alone. Axial neck pain improved in all patients. Nurick's disability index and fusion rate improved in 70% of the patients after conservative and surgical treatment.
Cervical spinal tuberculosis should be suspected in endemic patients with severe neck pain and progressive neurological deficit. Histopathology is the gold standard of tuberculosis diagnosis. Anti-tuberculosis drugs should be continued for at least 12 months. Radical anterior debridement and instrumented fusion has demonstrated favorable results. The posterior approach is an alternative treatment in patients when the anterior approach cannot be performed or as part of second-stage surgery.
颈椎结核较为罕见；然而，延迟诊断和治疗可能导致严重的、不可逆的神经功能恶化。本研究旨在报告颈椎结核的临床诊断和管理策略。
回顾性分析1998年至2013年期间清迈大学医院收治的18例患者（13例男性，5例女性）。患者平均年龄51.4岁（范围37 - 68岁）。通过病史、体格检查、X线片、磁共振成像（MRI）及组织取样进行诊断。大多数患者接受了抗结核治疗（ATT）并接受了手术治疗。平均随访期为12.8个月。
颈部轴向疼痛、四肢瘫、痉挛性步态和手部笨拙是主要症状。椎间盘狭窄、终板破坏和椎旁软组织肿胀是突出的影像学表现。MRI显示椎体前软组织钆增强、椎间盘T2高信号、椎体内骨内T2高信号以及椎间盘碎裂。13例患者接受了一期前路清创融合术。3例患者仅接受了后路融合术。所有患者的颈部轴向疼痛均有改善。经保守和手术治疗后，70%的患者Nurick残疾指数和融合率得到改善。
在有严重颈部疼痛和进行性神经功能缺损的地方流行区患者中应怀疑颈椎结核。组织病理学是结核诊断的金标准。抗结核药物应持续使用至少12个月。根治性前路清创和器械融合已显示出良好的效果。当无法进行前路手术或作为二期手术的一部分时，后路手术是患者的一种替代治疗方法。
