Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P107. The clinical efficacy of cervicothoracic tuberculosis by anterior approach surgery: a multicenter retrospective study

Abstract

BACKGROUND CONTEXT The term cervicothoracic usually refers to the C6-T3 spinal segment. Because of the deep location and the complicated anatomy, it is difficult for surgeons to expose the lesion. At the same time, the diameter of the thoracic spinal cord is small, the buffer space is restricted, and the spinal cord is close to the front, so anterior compression may cause severe spinal cord injury; also, blood supply to the upper thoracic cord is poor, and the circulation will be greatly affected when compression occurs PURPOSE This study evaluated the efficacy of anterior surgical approaches for the treatment of cervicothoracic tuberculosis, to discuss surgical approach selection, and to provide a reference for the treatment of cervicothoracic spinal tuberculosis. STUDY DESIGN/SETTING A retrospective cohort study. PATIENT SAMPLE Seventy-four patients. OUTCOME MEASURES Clinical outcome, laboratory indexes and radiological results. METHODS This research retrospectively analyzed 74 patients with cervicothoracic tuberculosis who were treated in six institutions. There were 37 males and 37 females with average ages of 24years (range 5–62 years). A total of 33 patients underwent one-stage anterior surgery (Group A); 16 underwent an anterior combined posterior surgery (Group B); and 25 underwent one-stage posterior surgery (Group C). Clinical outcome, laboratory indexes and radiological results were analyzed. RESULTS All cases were followed-up after about 36-96 months (average 39 months). At the last follow-up, patients in three groups had achieved bone fusion, with pain relief and neurological recovery. No major vessels and nerve injuries were found during the operation. There were significant differences before and after treatment in terms of VAS, NDI and JOA (P CONCLUSIONS One stage anterior approach surgery for the treatment of cervicothoracic tuberculosis has excellent efficacy and fewer complications, so it is the recommended surgical method. The indication for posterior-only approach is narrow and should be used selectively. However, the anterior combined posterior approach has a longer operative time, larger blood loss, and increased trauma, simultaneous with higher technical skills required for surgeons. Therefore, the indications should be strictly controlled.