EARLY RECOVERY AND STABILISATION WITH INSTRUMENTATION IN ANTERIOR CERVICAL SPINE TUBERCULOSIS

Raja RA Raja, Aleem -ud-Din Sheikh, Hussain M Hussain, Agani SA Agani

Abstract


Background: Tuberculous infection causes destruction, caseation, and necrosis of cervical vertebrae or
may present as an abscess. Complete recovery of neurological status is the rule after anterior surgical
decompression and fusion, even in cases with complete paraplegia or tetraplegia. Neurological
impairment and spinal deformity are the major concerns with spinal tuberculosis. Absolute nonoperative treatment was offered in pre antibiotic era. Since last decade great advances in terms of
operative options drastically changed the scenario in management of caries spine and indications for
surgery have been extended for early resolution of disease, quicker rehabilitation and prevention of late
complications. Methods: During the period from 2005 to 2012, 336 patients of spinal tuberculosis were
admitted in Department of neurosurgery, Liaquat University Hospital, Jamshoro. Forty-four patients
were considered for surgery. All 44 patients underwent decompression through anterior cervical
approach followed by fusion with iliac bone graft and then stabilization with titanium locking plate.
Results: There were 20 males and 24 females. Neck pain was the chief complaint and improved in all
cases. Patients had varying grades of motor weakness in upper and lower limbs. All the patients had
good neurological recovery after surgery. No postoperative surgical complication found in any patient.
Conclusion: Anterior cervical decompression, fusion and instrumentation with titanium plate fixation
in patients with tuberculous spondylitis gives excellent results without untoward effects.
Keywords: cervical spondylitis, Koch’s spine, anterior instrumentation, cervical plating

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References


Tuli SM. Tuberculosis of skeletal system, 2nd ed. New Delhi:

Jaypee Brothers; 1997. p.191–7.

Govender S, Charles R. Tuberculosis of the cervical spine

Neuro Orthop 1991;11:101–7.

Jain AK, Kumar S, Tuli SM. Tuberculosis of spine (C1 to

D4). Spinal Cord 1999;37:362–9.

Hayes AJ, Choksey M, Barnes N, Sparrow OC. Spinal

tuberculosis in developed countries: Difficulties in diagnosis.

J R Coll Surg Edinb 1996;41:192–6.

Grifftiths DLL. The treatment of spinal tuberculosis. Recent

advances in orthopaedics. Edinburg: Churchill Livingstone;

p. 1–17.

Medical Research Council Working Party on Tuberculosis of

the Spine. A controlled trial of anterior spinal fusion and

debridement in surgical management of tuberculosis of the

spine in patients on standard chemotherapy. A study in Hong

Kong. Br J Surg 1974;611:853–66.

Moon MS, Moon JL, Kim SS, Moon YW. Treatment of

tuberculosis of the cervical spine: operative versus

nonoperative. Clin Orthop Relat Res 2007;460:67–7.

Aksoy MC, Acaroglu RE, Tokgozoglu AM, Ozdemir N,

Surat A. Retrospective evaluation of treatment methods in

tuberculosis spondylitis. Hacettepe J Orthop Surg

;5:207–9.

Slucky AV, Eismont FJ. Spinal infections. In: Bridwell KH,

DeWald RL, (Eds). The Textbook of Spinal Surgery.

Philadelphia: Lippincott; 1997.p. 2141–83.

Jain AK. Treatment of tuberculosis of the spine with

neurological complications. Clin Orthop Relat Res

;398:75–84.

Oga M, Arizono T, Takasita M, Sugioka Y. Evaluation of the

risk of instrumentation as a foreign body in spinal

tuberculosis: Clinical and biologic study. Spine

;18:1890–4.

Guven O, Kumano K, Yalcin S, Karahan M, Tsuji S. A

single stage posterior approach and rigid fixation for

preventing kyphosis in the treatment of spinal tuberculosis.

Spine 1994;19:1039–43.

Raja RA, Naeem-ur-Razaq M, Shaikh SA, Khan H. Outcome

of cervical disectomy and fusion with stabilization in single

level cervical disc. J Ayub Med Coll Abbottabad

;22(2):180–3.

Raja RA, Makhdoom A, Qureshi AA. Anterior

decompression, fusion and plating in cervical spine injury:

our early experience. J Ayub Med Coll Abbottabad

;20(4):73–6.

Lanzieri C. Magnetic resonance imaging of infections of the

spine. In: Haaga JR, Lanzieri CF, Gilkeson RC, (Eds). CT

and MR imaging of the whole body. 4th ed. St. Louis:

Missouri EUA; 2003. p. 809–10.

Desai SS. Early diagnosis of spinal tuberculosis by MRI. J

Bone Joint Surg Br 1994; 76:863–9.

Gupta RK, Agarwal P, Rastagi H, Kumar S, Phadke

RV, Krishnani N. Problems in distinguishing spinal

tuberculosis from neoplasia on MRI. Neuroradiology

;38(suppl 1):97–104.

Rezai AR, Lee M, Cooper PR, Cooper PR, Errico TJ, Koslow

M. Modern management of spinal tuberculosis. Neurosurgery

;36:87–9.

Nussbaum E, Gaylan LR, Bergman TA, Erickson

DL

, Seljeskog EL. Spinal tuberculosis: a diagnostic and

management challenge. J Neurosurg 1995;83:243–7.

Faraj AA. Anterior instrumentation for the treatment of

spinal tuberculosis. J Bone Joint Surg Am 2001;83:463–4.

Hodgson AR, Stock FE. Anterior spine fusion for the

treatment of tuberculosis of the spine .J Bone Joint Surgery

Am 1960;42:295–310.

Hassan MG. Anterior plating for lower cervical spine

tuberculosis. Int Orthop 2003;27:73–7.

Moon MS. Tuberculosis of the spine. Controversies and a

new challenge. Spine 1997;22:1791–7.

Rajasekaran S, Soundarpandian S. Progression of kyphosis in

tuberculosis of the spine treated by anterior arthrodesis. J

Bone Joint Surg Am 1989;74:1314–23.

Kemp HBS, Jackson JW, Jeremiah JD, Cook J. Anterior

fusion of the spine for infective lesions in adults. J Bone Joint

Surg Br 1973;55:715–34.

Loembe PM, Mwanyombet-Ompounga L, Assengone-Zeh

Y, Kengue-Lechiombeka PR. Early anterolateral surgery for

tuberculosis of the lower cervical spine with neurological

complications in adults. Our experience in Gabon.

Neurochirugie 2000;46:541–8.


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