Medium-Term Follow-Up Outcomes of One-Stage Posterior Lumbosacral or Lumbopelvic Fixation in the Management of Lumbosacral Junction Tuberculosis in Adults

Surgical treatment of spinal tuberculosis: an updated review

Tuberculosis (TB) is a worldwide disease which seriously affects the global public health. Spinal TB is the most common extra-pulmonary TB and may cause vertebral bone destruction, collapse, kyphosis and even paralysis. Anti-TB chemotherapy is considered the cornerstone treatment of spinal TB and surgery is often required for patients with severe kyphosis, impaired neurological function or spinal instability. Debridement of TB lesions, bone grafting and internal fixation are the key procedures of spinal TB surgery. However, the selection of surgical approach, the extent of TB lesion debridement, the choice of bone graft materials, and the method and extent of internal fixation are all remain controversy. The aim of this updated review is to evaluate current literature for advances in management of spinal TB, with particular focus on surgical techniques.

Endoscopy-assisted anterior cervical debridement combined with posterior fixation and fusion for the treatment of upper cervical spine tuberculosis: a retrospective feasibility study

Background

This retrospective study aimed to determine the feasibility and efficacy of endoscopy-assisted anterior cervical debridement combined with posterior fixation and fusion in patients with upper cervical spine tuberculosis.

Methods

Between June 2008 and January 2016, 17 patients (10 men and 7 women) with upper cervical spine tuberculosis underwent endoscopy-assisted anterior cervical debridement combined with posterior fixation and fusion. Anti-tuberculosis treatment was administered for 2–4 weeks preoperatively and 12–18 months postoperatively. The clinical and radiographic data of the patients were analyzed.

Results

The operation was successfully completed in all patients. Neck pain and stiffness were relieved after the surgery in all patients. The mean operation time was 210.0 ± 21.2 min, and the mean intraoperative blood loss was 364.7 ± 49.6 mL. The mean follow-up duration was 68.1 ± 6.7 months. The erythrocyte sedimentation rate returned to normal by 3 months postoperatively. Visual analog scale scores for neck pain were significantly lower postoperatively than preoperatively. All patients had significant postoperative neurological improvement. Patient-reported outcomes, as measured using the Kirkaldy-Willis criteria, were as follows: excellent, 12 patients; good, 4 patients; fair, 1 patient; and poor, 0 patients. Bone fusion was achieved at 10.9 ± 1.9 months after the surgery; no cases of instrument loosening or fracture occurred.

Conclusion

Endoscopy-assisted anterior cervical debridement combined with posterior fixation and fusion is a feasible and effective surgical method for the treatment of upper cervical spine tuberculosis. It can be used to restore upper cervical spine stability and facilitate spinal healing.