Department of Orthopaedic Surgery, PD Hinduja Hospital and Medical Research Centre, Mumbai 400.016, India.
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Neurosurgery, Mayo Clinic, Rochester, MN 55905, USA.
Clin Neurol Neurosurg. 2022 Nov;222:107453. doi: 10.1016/j.clineuro.2022.107453. Epub 2022 Sep 28.
To describe a management algorithm for cervicovertebral junction (CVJ) TB based upon disease severity and neurological status at presentation.
Retrospective cohort study of 52 patients treated for microbiologically or clinically-diagnosed CVJ TB at a tertiary referral center in a TB endemic area were identified. Data were gathered about presenting symptoms, baseline neurological status, management strategy, and management outcomes. Patients were categorized by a modified Lifeso Stage.
Fifty-two patients were included (Mean age 28.5 ± 13.4 yr, 48% male): 18 Lifeso Stage I, 15 Stage II, and 19 Stage III. All presented with pain, 19 (37%) with neurological symptoms, and 5 with inability to ambulate. Stage II and III patients were more commonly myelopathic at presentation (p < 0.01) than Stage I patients. Only Stage II/III lesions required traction or surgical intervention; Stage III lesions more commonly required surgery than Stage II lesions (100% vs. 73%; p = 0.03). Among surgically-treated Stage II and III lesions, Stage III lesions had longer symptom prodromes (5.1 ± 2.2 vs. 3.3 ± 1.4mo; p = 0.03), more commonly had lateral mass collapse at presentation (58 vs. 9%; p = 0.02), and more commonly required occipitocervical fusion (68 vs. 9%; p < 0.01).
Based upon these data, Stage I lesions may be treated conservatively, unless presenting with a neurological deficit. Conversely, Stage III lesions require open reduction and instrumentation due to irrevocable underlying bony damage. Reducible Stage II lesions with absent or mild neurological symptoms can be treated conservatively, but irreducible lesions and those with concomitant neurological deficits merit surgery.
根据疾病严重程度和发病时的神经状态，描述颈椎关节结核（CVJ）的管理算法。
回顾性分析了在一个结核病流行地区的三级转诊中心接受微生物学或临床诊断为 CVJ 结核治疗的 52 例患者。收集了患者的主要症状、基线神经状态、治疗策略和治疗结果。患者按照改良 Lifeso 分期进行分类。
52 例患者入选（平均年龄 28.5±13.4 岁，48%为男性）：18 例 Lifeso Ⅰ期，15 例 Lifeso Ⅱ期，19 例 Lifeso Ⅲ期。所有患者均表现为疼痛，19 例（37%）有神经症状，5 例有行走障碍。Ⅱ期和Ⅲ期患者的脊髓病更为常见（p＜0.01）。仅Ⅱ期和Ⅲ期病变需要牵引或手术干预；Ⅲ期病变比Ⅱ期病变更常需要手术（100% vs. 73%；p=0.03）。在接受手术治疗的Ⅱ期和Ⅲ期病变中，Ⅲ期病变的症状前驱期更长（5.1±2.2 vs. 3.3±1.4mo；p=0.03），更常伴有横突骨块塌陷（58% vs. 9%；p=0.02），更常需要枕颈融合（68% vs. 9%；p＜0.01）。
根据这些数据，Ⅰ期病变除非有神经缺损，否则可以保守治疗。相反，由于不可逆转的基础骨损伤，Ⅲ期病变需要切开复位和内固定。无或轻度神经症状的可复位Ⅱ期病变可以保守治疗，但不可复位病变和伴有神经缺损的病变需要手术治疗。
