Cervicothoracic Tuberculosis Research Articles

Cervical spine TB - Current concepts in management.

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. Literature search: 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.

Clinical Efficacy of Three Surgical Approaches for the Treatment of Cervicothoracic Tuberculosis: A Multicenter Retrospective Study.

ObjectiveTo evaluate the efficacy of three surgical approaches for the treatment of cervicothoracic tuberculosis.MethodsThis is a multicenter retrospective study. We analyzed 74 patients with cervicothoracic tuberculosis who were treated in six institutions between January 2000 and January 2015. There were 37 male and 37 female patients, with an average age of 24 years (range, 5–62 years). The operative method was selected according to the indications. A total of 33 patients underwent one‐stage anterior surgery (group A); 16 underwent a combined anterior and posterior surgery (group B) and 25 underwent one‐stage posterior surgery (group C). Clinical outcomes, laboratory indexes, and radiological results were analyzed.ResultsAll cases were followed up for approximately 36–96 months post‐surgery (average, 39 months). At the last follow‐up, patients in all three groups had achieved bone fusion, with pain relief and neurological recovery. No major vessel and nerve injuries were found during the operation. There were significant differences before and after treatment for visual analogue scale (VAS), neck disability index (NDI), and Japanese Orthopedic Association (JOA) score (P < 0.001). Three surgical strategies significantly improved kyphosis (P < 0.001).ConclusionThe choice of operation for cervicothoracic tuberculosis should be selected based on the pathological changes, scope, and general physical condition of the patient. The indication for a posterior approach is narrow and it should be used selectively. The combined anterior and posterior approach involved a longer operating time, larger blood loss, and greater trauma, and also required a higher level of surgical skill. Therefore, the indications for this approach should be strictly controlled. Anterior approach surgery for the treatment of cervicothoracic tuberculosis showed excellent efficacy and fewer complications.

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

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.

Debridement and Bone Grafting With Internal Fixation via Anterior Approach for Treatment of Cervicothoracic Tuberculosis

The objective of this study was to investigate the outcome of the patients with cervicothoracic tuberculosis who underwent radical debridement, reconstruction with bone autograft or allograft, and plate internal fixation via anterior approach. From June 2000 to December 2010, 20 patients with tuberculosis in cervicothoracic junction underwent a standard cervical approach, which was combined with a partial median osteotomy and transverse osteotomy through the synostosis between the manubrium and body of the sternum to expose the lesion adequately. Radical debridement was performed, then tricortical iliac crest bone autograft or allograft was placed and internal fixation was done to reconstruct the spinal column. The pathologic change regions were as follows: 10 in the C7-T1 segment, 6 in the T1 segment, 3 in the T1-T3 segment, and 1 in the T2-T3 segment. The classifications of Frankel were as follows: 2 at grade A, 4 at grade B, 7 at grade C, 2 at grade D, and 5 at grade E. There was no injury of blood vessel, spinal cord, or recurrent nerve during the surgery. The follow-up period ranged approximately 16 to 39 months. Bony fusion was obtained in all patients, and there was no internal fixation failure and tuberculosis recurrence in any of these patients. The nerve function of the spinal cord recovered at different degrees: 2 at grade A, 1 at grade B, 1 at grade C, 3 at grade D, and 13 at grade E. The anterior approach can provide direct and safe access to the lesion. The structural iliac crest autograft or allograft and anterior instrumentation could work effectively to stabilize the cervicothoracic junction.

One-stage posterior focus debridement, fusion, and instrumentation in the surgical treatment of cervicothoracic spinal tuberculosis with kyphosis in children: a preliminary report

To determine the efficacy and feasibility of surgical management of cervicothoracic tuberculosis accompanied by kyphosis in children by using one-stage posterior focus debridement, bone graft fusion, and instrumentation at a single institution. Ten consecutive cases with cervicothoracic tuberculosis with kyphosis were treated with one-stage posterior focus debridement, bone graft fusion, and instrumentation. The mean follow-up was 36 months (range 26-47 months). The kyphotic angle ranged from 35° to 62° before operation, 50.5° in average. The American Spinal Injury Association score system was used to evaluate the neurological deficits. Spinal tuberculosis was completely cured in all ten patients. There was no recurrent tuberculous infection. The postoperative kyphotic angle was 10° to 22°, 17.5° in average, and there was no significant loss of the correction at the latest follow-up. Solid fusion was achieved in all cases. Neurological condition in all patients was improved after surgery. One-stage posterior debridement, bone grafting, and instrumentation can be an effective treatment method of cervicothoracic spinal tuberculosis with kyphosis in children.

Anterior Instrumentation of the Cervicothoracic Vertebrae

Anterior instrumentation was performed in 42 cases of cervicothoracic tuberculosis operated using the modified anterior cervical approach. To define the role of the modified anterior cervical approach in anterior reconstruction and instrumentation of the cervicothoracic vertebrae. To analyze the problems encountered during anterior stabilization in these patients. In tuberculosis of cervicothoracic junction, direct anterior visualization is mandatory for optimal decompression of the spinal canal. Anterior reconstruction and stabilization has the advantage of providing immediate stability of vertebral column. The modified anterior cervical approach provides adequate exposure of the upper four thoracic vertebrae. However, radiologic and clinical criteria for anterior instrumentation of the cervicothoracic junction using the modified anterior cervical approach are unclear in literature. A total of 42 patients with tuberculous kyphosis involving the cervicothoracic junction were operated. Based on the association of the sternal notch with the most distal normal vertebra, the patients were divided into 2 surgical groups. The long-neck patients were amenable to anterior instrumentation using the standard supraclavicular approach with a strap-muscle tenotomy. A manubriotomy was mandatory in short-neck patients for optimal visualization and proper placement of the implant. Anterior reconstruction and instrumentation of the cervicothoracic junction offers a distinct advantage of a stable implant-bone construct anteriorly while preserving the posterior osseo-ligamentous tension band. Detailed preoperative assessment based on clinical and radiologic criteria helps in selection of patient for this procedure. Meticulous intraoperative technique helps to minimize the morbidity and complications associated with this procedure.