EARLY RECOVERY AND STABILISATION WITH INSTRUMENTATION IN ANTERIOR CERVICAL SPINE TUBERCULOSIS
AbstractBackground: Tuberculous infection causes destruction, caseation, and necrosis of cervical vertebrae ormay present as an abscess. Complete recovery of neurological status is the rule after anterior surgicaldecompression and fusion, even in cases with complete paraplegia or tetraplegia. Neurologicalimpairment 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 ofoperative options drastically changed the scenario in management of caries spine and indications forsurgery have been extended for early resolution of disease, quicker rehabilitation and prevention of latecomplications. Methods: During the period from 2005 to 2012, 336 patients of spinal tuberculosis wereadmitted in Department of neurosurgery, Liaquat University Hospital, Jamshoro. Forty-four patientswere considered for surgery. All 44 patients underwent decompression through anterior cervicalapproach 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 allcases. Patients had varying grades of motor weakness in upper and lower limbs. All the patients hadgood neurological recovery after surgery. No postoperative surgical complication found in any patient.Conclusion: Anterior cervical decompression, fusion and instrumentation with titanium plate fixationin patients with tuberculous spondylitis gives excellent results without untoward effects.Keywords: cervical spondylitis, Koch’s spine, anterior instrumentation, cervical plating
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;
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
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
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
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.
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
Raja RA, Makhdoom A, Qureshi AA. Anterior
decompression, fusion and plating in cervical spine injury:
our early experience. J Ayub Med Coll Abbottabad
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
Rezai AR, Lee M, Cooper PR, Cooper PR, Errico TJ, Koslow
M. Modern management of spinal tuberculosis. Neurosurgery
Nussbaum E, Gaylan LR, Bergman TA, Erickson
, 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
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.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.