Jain Anil K, Dhammi Ish K, Arora Rajesh, Gain Amartya
Department of Orthopaedics, University College of Medical Sciences and GTB Hospital (University of Delhi), Dilshad Garden, New Delhi, India.
J Clin Orthop Trauma. 2024 Apr 24;52:102420. doi: 10.1016/j.jcot.2024.102420. eCollection 2024 May.
Tuberculosis (TB) of CT junction is uncommon (5 % of all spinal TB), and difficult to approach surgically in view of its deep location with sternum in front and scapula in the back. We present 7 consecutively treated cases of cervico-thoraccic TB for outcome of treatment and discuss rationale of choosing surgical approach.
Present study includes 7 freshly diagnosed cases of CT junction TB. Plain radiographs, sagittal reconstruction of CT spine that included sternum on CT/MRI was performed in all cases. Disc space below the distal healthy vertebrae was identified and a line parallel to disc space was drawn. If this line passes above suprasternal notch, it was inferred that this VB can be accessed by anterior cervical approach. If disease focus was at or below suprasternal notch level, manubriotomy/sternotomy was added for better visualization of the lesion.
All seven cases were female, with mean age of 20 years (9-45 years). The vertebral lesion involved 2VB (n = 3), 3VB (n = 2) and >3 VB (n = 2). The average Cervico-thoracic kyphosis was 15° (range 10-25°). All 7 cases were operated for anterior decompression, kyphotic deformity correction and instrumented stabilization. Anterior cervical approach and manubriotomy/sternotomy approach was performed in three cases each. In two pan-vertebral cases we performed 360° procedure. Six cases have shown first sign of neural recovery within 3 weeks of surgery and almost complete neural recovery at 3 months follow-up while one case showed partial recovery. ATT was stopped after 12 months once healed stage was demonstrated on contrast MRI in all.
CT junction TB usually presents with severe kyphotic deformity/neural deficit. These cases require anterior decompression/corpectomy, deformity correction, gap grafting and instrumented stabilization with anterior cervical plate. Lesion with pan-vertebral disease is stabilized 360°. These lesions can be decompressed by lower anterior cervical approach with/without manubriotomy. The Karikari method was useful in deciding the need for manubriotomy to decompress the lesion.
颈胸段结核并不常见（占所有脊柱结核的5%），鉴于其位置较深，前方有胸骨，后方有肩胛骨，手术治疗难度较大。我们报告7例连续接受治疗的颈胸段结核病例的治疗结果，并讨论选择手术入路的理由。
本研究包括7例新诊断的颈胸段结核病例。所有病例均进行了X线平片检查，以及包括胸骨的CT/MRI脊柱矢状面重建。确定远端健康椎体下方的椎间盘间隙，并绘制一条与椎间盘间隙平行的线。如果这条线经过胸骨上切迹上方，则推断可以通过颈前路进入该椎体。如果病灶位于胸骨上切迹水平或以下，则增加胸骨柄切开术/胸骨切开术以更好地观察病变。
所有7例均为女性，平均年龄20岁（9 - 45岁）。椎体病变累及2个椎体（n = 3）、3个椎体（n = 2）和超过3个椎体（n = 2）。平均颈胸段后凸畸形为15°（范围10 - 25°）。所有7例均接受了前路减压、后凸畸形矫正和器械固定手术。3例采用颈前路手术，3例采用胸骨柄切开术/胸骨切开术。在2例全椎体病例中，我们进行了360°手术。6例在术后3周内出现神经恢复的首个迹象，在3个月随访时几乎完全神经恢复，而1例显示部分恢复。所有病例在对比MRI显示愈合阶段后，12个月后停用抗结核治疗。
颈胸段结核通常表现为严重的后凸畸形/神经功能缺损。这些病例需要前路减压/椎体切除、畸形矫正、椎间植骨和使用颈椎前路钢板进行器械固定。全椎体病变的病灶采用360°固定。这些病灶可通过低位颈前路入路，加或不加胸骨柄切开术进行减压。卡里卡里方法有助于确定是否需要胸骨柄切开术来减压病灶。
