Wu Yunfeng, Yang Xiyou, Yu Long, Liu Ning, Yang Shangjie, Cui Xu
College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan Province, China.
Department of Orthopedics, The Eighth Medical Centre, Chinese PLA General Hospital, Beijing, China.
Orthop Surg. 2025 Jun;17(6):1732-1741. doi: 10.1111/os.70047. Epub 2025 May 1.
The treatment of tuberculosis at the craniovertebral junction (CVJ) remains challenging, with significant debate surrounding therapeutic approaches. Halo vest (HV) therapy provides a non-invasive immobilization alternative, while occipitocervical fusion (OCF) offers a surgical option. However, limited evidence exists comparing the efficacy of HV therapy with OCF for CVJ tuberculosis. This study aimed to evaluate the clinical outcomes and safety of HV immobilization in treating CVJ tuberculosis, compared with OCF.
This retrospective cohort study was conducted from January 2012 to December 2022 and included 43 patients diagnosed with CVJ tuberculosis. Radiographic and treatment data were meticulously analyzed to compare outcomes between patients treated with HV immobilization (Group H, n = 22) and those undergoing OCF (Group O, n = 21). Interventions comprised at least 28 weeks of HV immobilization for Group H and OCF supplemented with postoperative external fixation for Group O. Outcomes were evaluated using the Visual Analog Scale (VAS-neck), erythrocyte sedimentation rate (ESR), and radiographic stability (assessed via X-ray and CT). Statistical analyses included the Student's t-test (parametric data), Mann-Whitney U test (nonparametric data), and chi-square test (categorical variables), with a significance level set at p < 0.05.
Over a 24-month follow-up, all patients exhibited successful healing of tuberculosis lesions. Group H demonstrated greater improvements in cervical flexion-extension and rotation function compared with Group O. Both groups showed statistically significant decreases in Visual Analog Scale (VAS-neck) and Neck Disability Index (NDI) scores, as well as in ESR and C-reactive protein (CRP) values from pre-surgery levels (p < 0.01). Notably, differences in VAS-neck (1 month) and NDI (24 months) between the groups were statistically significant (p < 0.05), while no significant differences were observed in other follow-up periods (p > 0.05). Additionally, there were no significant differences in ESR and CRP values at any time point between the treatment groups (p > 0.05).
The study yielded satisfactory outcomes for all patients. Short-term differences in pain relief did not significantly impact the healing of CVJ tuberculosis. Patients receiving HV treatment showed greater improvement in neck function compared with those undergoing occipitocervical fusion. Given the substantial costs and risks associated with open surgery, we advocate for conservative treatment utilizing HV.
颅颈交界区（CVJ）结核的治疗仍然具有挑战性，围绕治疗方法存在重大争议。头环背心（HV）疗法提供了一种非侵入性固定替代方案，而枕颈融合术（OCF）则提供了一种手术选择。然而，比较HV疗法与OCF治疗CVJ结核疗效的证据有限。本研究旨在评估与OCF相比，HV固定治疗CVJ结核的临床疗效和安全性。
本回顾性队列研究于2012年1月至2022年12月进行，纳入43例诊断为CVJ结核的患者。对影像学和治疗数据进行了细致分析，以比较接受HV固定治疗的患者（H组，n = 22）和接受OCF治疗的患者（O组，n = 21）之间的疗效。干预措施包括H组至少28周的HV固定，O组的OCF并辅以术后外固定。使用视觉模拟量表（VAS-颈部）、红细胞沉降率（ESR）和影像学稳定性（通过X线和CT评估）来评估疗效。统计分析包括Student's t检验（参数数据）、Mann-Whitney U检验（非参数数据）和卡方检验（分类变量），显著性水平设定为p < 0.05。
在24个月的随访中，所有患者的结核病灶均成功愈合。与O组相比，H组在颈椎屈伸和旋转功能方面有更大改善。两组的视觉模拟量表（VAS-颈部）和颈部功能障碍指数（NDI）评分以及ESR和C反应蛋白（CRP）值与术前水平相比均有统计学显著下降（p < 0.01）。值得注意的是，两组之间VAS-颈部（1个月）和NDI（24个月）的差异有统计学意义（p < 0.05），而在其他随访期未观察到显著差异（p > 0.05）。此外，治疗组之间在任何时间点的ESR和CRP值均无显著差异（p > 0.05）。
该研究对所有患者均产生了满意的结果。疼痛缓解方面的短期差异并未显著影响CVJ结核的愈合。与接受枕颈融合术的患者相比，接受HV治疗的患者颈部功能改善更大。鉴于开放手术的巨大成本和风险，我们提倡采用HV进行保守治疗。
