Srivastava Sudhir, Raj Aditya, Bhosale Sunil, Purohit Shaligram, Marathe Nandan, Shah Swapneel
Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
J Craniovertebr Junction Spine. 2020 Apr-Jun;11(2):86-92. doi: 10.4103/jcvjs.JCVJS_53_20. Epub 2020 Jun 5.
Tuberculosis (TB) of the subaxial cervical spine has a high percentage of morbidity. It accounts for about 10% of cases with the major concerns being quadriparesis and localized kyphosis.
The study aims to provide an insight in the management of subaxial cervical spine TB treated by multiple modalities.
A retrospective analysis of 91 patients with subaxial cervical (C3-C7) TB was performed. Neurology was assessed by Nurick's grading and pain using the visual analog scale (VAS) (in mm). Radiological evaluation was done with standard anteroposterior and lateral view of the cervical spine at presentation and 3 monthly intervals after intervention. Magnetic resonance imaging was done in all patients. Angle of kyphosis (K angle) was calculated from plain radiographs.
Mean age of the patients was 31.5 years. Neurological status was Nurick's Grade 5 in 8, Grade 4 in 15, Grade 3 in 28, Grade 2 in 22, Grade 1 in 7, and further 11 had Nurick's Grade 0. Operative intervention was either anterior, or posterior, or a combination of both depending on extent of vertebral destruction. All patients with Nurick's 5 and 4 improved to 3 or less at final follow-up. The kyphosis angle at presentation ranged from 2° to 58° of with an average kyphosis of 16.05°. The postoperative kyphosis was graded as mild (loss of lordosis to 10° kyphosis), moderate (10°-30°), and severe (>30°). Ten patients had mild kyphosis and 6 patients had moderate kyphosis. Mean VAS score at presentation was 45.5 mm which improved to 14.48 mm at follow-up. Patients with mild and moderate kyphosis remained asymptomatic till the last follow-up.
Healing of subaxial cervical TB in kyphosis does not necessitate a poor clinical outcome as most patients remain asymptomatic.
下颈椎结核发病率较高。约占所有病例的10%，主要问题是四肢瘫痪和局部后凸。
本研究旨在深入了解多模式治疗下颈椎结核的方法。
对91例下颈椎（C3-C7）结核患者进行回顾性分析。采用Nurick分级评估神经功能，用视觉模拟量表（VAS，单位为mm）评估疼痛程度。在初诊时及干预后每3个月进行颈椎标准正侧位X线检查进行影像学评估。所有患者均行磁共振成像检查。根据X线平片计算后凸角（K角）。
患者平均年龄31.5岁。神经功能状态：Nurick 5级8例，4级15例，3级28例，2级22例，1级7例，另有11例为Nurick 0级。根据椎体破坏程度，手术干预方式为前路、后路或前后联合。所有Nurick 5级和4级患者在末次随访时均改善至3级或更低。初诊时后凸角范围为2°至58°，平均后凸角为16.05°。术后后凸分为轻度（前凸消失至后凸10°）、中度（10°-30°）和重度（>30°）。10例患者为轻度后凸，6例患者为中度后凸。初诊时平均VAS评分为45.5mm，随访时改善至14.48mm。轻度和中度后凸患者直至末次随访均无症状。
下颈椎结核后凸畸形的愈合并不一定导致不良临床结局，因为大多数患者无症状。
