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| WEI Feng,LIU Xiaoguang,LIU Zhongjun.Diagnosis and treatment of upper cervical tuberculosis[J].Chinese Journal of Spine and Spinal Cord,2011,(10):802-806. |
| Diagnosis and treatment of upper cervical tuberculosis |
| Received:December 29, 2010 Revised:March 14, 2011 |
| English Keywords:Upper cervical spine Tuberculosis Diagnosis Treatment |
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| 【Abstract】 Objective：To investigate the determination and treatment of upper cervical tuberculosis.Method：29 patients suffering from upper cervical tuberculosis and treated surgically between January 1998 and December 2008 were reviewed retrospectively.There were 18 males and 11 females with age ranging from 2 to 64 years old（mean，33.6 years old）.9 cases had neurological deficits including 3 Frankel C and 6 Frankel D.8 cases had C1 involved；11 had C2 involved；and 10 had both C1 and C2 involved.Bony lesion was noted in all patients.10 patients were complicated with atlantoaxial dislocation.CT-guided fine-needle aspiration biopsy was performed in 27 patients；while 2 failed due to young age，so the tuberculosis was confirmed by the intra-operative biopsy.All patients received 18 months routine antituberculous chemotherapy and respective surgical intervention.The classification for upper cervical tuberculosis grading system presented in our institute was used in all cases（grade Ⅰ：mild to moderate bony destruction，grade Ⅱ：severe bony destruction combined with atlantoaxial dislocation，grade Ⅲ：grade Ⅰ or grade Ⅱ plus neurological deficits）.The clinical outcome surgical intervention of varied grade cases was reviewed.Result：11 of 12 cases of grade Ⅰ experienced Halo-vest external fixation for 5-8 months，while the other 1 wear hard collar for 3 months due to no obvious bony destruction.8 cases of grade Ⅱ underwent skull traction followed by Halo-vest external fixation，6 of whom underwent debridement and fusion followed by Halo-vest for 3 months，while the other 2 cases underwent Halo-vest external fixation alone for 6 months.9 cases of grade Ⅲ underwent decompression and fusion followed by Halo-vest for 3-6 months.All patients were followed up for a mean of 30 months（range，18-84 months）.All patients with neuro-logical deficit improved to Frankel E.Radiology demonstrated absence of paravertebral abscess，bony fusion and good alignment of C1/2 achieved in all cases.And there was no tuberculosis recurrence during the follow-up.Conclusion：Pathological determination is critical for upper cervical tuberculosis.The patients with neurological defect should be managed by surgery or dislocation reduction.The surgery should be simple and effective aiming at decompression.The patients with intact neurological status can be treated non-operatively.Atlantoaxial dislocation can be reduced by skull traction and maintained by Halo-vest with perfect outcome.Routine chemotherapy is the key for the prognosis. |
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