Department of Spine surgery, 76290Ganga Medical Centre and Hospital, Coimbatore, Tamil Nadu, India.
J Orthop Surg (Hong Kong). 2021 Sep 1;29(1_suppl):23094990211006936. doi: 10.1177/23094990211006936.
Cervical tubercular disease (CTB) is a rare pathology and constitutes 3-5% of all spinal TB. It includes atlantoaxial TB and sub-axial TB. As the literature evidence on this subject is scarce, majority of issues concerning CTB are still controversial. The current narrative review comprehensively discusses the various aspects related to CTB. An elaborate search was made using keywords cervical tuberculosis, atlantoaxial tuberculosis, sub-axial tuberculosis, and cervico-thoracic tuberculosis, on pubmed and google (scholar.google.com) databases on 2 December 2020. We identified crucial questions regarding CTB and included relevant articles pertaining to them.
The initial search using keywords cervical tuberculosis, atlantoaxial tuberculosis, sub-axial tuberculosis, and cervico-thoracic tuberculosis yielded 4128, 76, 3 and 9 articles on 'pubmed' database, respectively. A similar search using the aforementioned keywords yielded 1,96,000, 2130, 117 and 728 articles on 'google scholar' database. The initial screening resulted in the identification of 178 articles. Full manuscripts were obtained for these articles and thoroughly scrutinised at the second stage. Review articles, randomised controlled trials and level 1 studies were given preference. Overall, 41 articles were included.
AATB and SACTB constitute 0.3 to 1% and 3% of spinal TB, respectively. The incidence of neuro-deficit in CTB is significantly more than other spinal TB. The general principles of management of CTB are similar to spinal TB elsewhere and medical therapy remains the cornerstone. Surgery is advocated in specific scenarios involving gross neuro-deficit, later stages of disease with significant bony/ligamentous disruptions, altered sagittal balance, drug resistance, and poor response to medications. The surgical approaches for AATB include anterior-alone, posterior-alone and combined approaches, although posterior access is the most preferred. Most of the studies on SACTB have supported the role of anterior approach. Additionally, posterior stabilisation may be necessary in specific scenarios. The overall long-term outcome in CTB is favourable.
颈椎结核（CTB）是一种罕见的疾病，占所有脊柱结核的 3-5%。它包括寰枢椎结核和下颈椎结核。由于这方面的文献证据很少，大多数与 CTB 相关的问题仍然存在争议。目前的叙述性综述全面讨论了与 CTB 相关的各个方面。2020 年 12 月 2 日，我们在 pubmed 和谷歌（scholar.google.com）数据库中使用关键词“颈椎结核”、“寰枢椎结核”、“下颈椎结核”和“颈胸段结核”进行了详细的搜索。我们确定了与 CTB 相关的关键问题，并纳入了与之相关的文章。
使用关键词“颈椎结核”、“寰枢椎结核”、“下颈椎结核”和“颈胸段结核”在 pubmed 数据库中分别检索到 4128、76、3 和 9 篇文章。在谷歌学术数据库中使用相同的关键词进行类似的搜索，分别检索到 196000、2130、117 和 728 篇文章。初步筛选确定了 178 篇文章。对这些文章进行了全文检索，并在第二阶段进行了详细审查。综述文章、随机对照试验和 1 级研究优先考虑。总的来说，有 41 篇文章被纳入。
AATB 和 SACTB 分别占脊柱结核的 0.3%至 1%和 3%。CTB 的神经功能缺损发生率明显高于其他脊柱结核。CTB 的治疗原则与其他部位的脊柱结核相似，药物治疗仍然是基石。手术适用于存在明显神经功能缺损、疾病晚期有明显骨/韧带破坏、矢状位平衡改变、药物耐药和药物反应不佳等特定情况。AATB 的手术入路包括前路单独、后路单独和联合入路，尽管后路是最常用的。大多数关于 SACTB 的研究都支持前路的作用。此外，在特定情况下可能需要后路稳定。CTB 的总体长期预后良好。
