One-stage surgical management for tuberculosis of the upper cervical spine by posterior debridement, short-segment fusion, and posterior instrumentation in children

Abstract

Purpose: To evaluate the clinical study efficacy and feasibility of 11 children with tuberculosis of the upper cervical spine treated by one-stage posterior debridement, short-segment fusion, and posterior instrumentation.

Methods: Eleven children who suffered from tuberculosis of the upper cervical spine were admitted to our hospital between June 2005 and December 2010. All of them were treated by one-stage posterior debridement, short-segment fusion, and posterior instrumentation. Then, the clinical efficacy was evaluated using statistical analysis based on the materials about the visual analogue scale (VAS) scores of pain, JOA scores of nerve function and erythrocyte sedimentation rate (ESR), which were collected at certain time.

Results: The average follow-up period was 28.1 ± 10.5 months (13-42 months). In the 11 cases, no postoperative complications related to instrumentation occurred and neurologic function was improved in various degrees. The average pretreatment ESR was 58.4 ± 4.9 mm/h (53-69 mm/h), which got normal (8.9 ± 6.5 mm/h) within 3 months in all patients. The average preoperative VAS was 7.4 ± 2.2, which decreased to 1.6 ± 1.8 postoperatively. Mean preoperative JOA was 11.2 ± 3.8, and the JOA at the last visit was 16.3 ± 1.0. All patients got bony fusion within 3-8 months after surgery.

Conclusions: One-stage posterior debridement, short-segment fusion, and posterior instrumentation can be an effective treatment method for the treatment of tuberculosis of the upper cervical spine in children.

Fig. 1

A 14-year-old female, axis destruction and formation of epidural cold abscess, posterior debridement, short-segment fusion, and posterior instrumentation in C1–C3, preoperative ASIA Grade was B grade, and at the final follow-up was D grade. Preoperative radiography showed destructive segments located at C2 and preoperative CT and MRI showed C2 vertebral body was almost vanished and abscess was localized (a–d). Postoperative roentgenographs and CT showed atlas with bilateral pedicle screws, axis with left pedicle screw and C3 with bilateral lateral mass screw (e–h). Twenty-five month’s postoperative roentgenographs showed internal fixation with good and bone fusion (i)

Fig. 2

A 12-year-old male, axis destruction and formation of epidural cold abscess, posterior debridement, short-segment fusion, and posterior instrumentation in C1–C2, preoperative ASIA Grade was C grade, and at the final follow-up was E grade. Preoperative CT showed C2 vertebral body was almost vanished and abscess was localized (a, b). Thirty-six month’s postoperative CT showed that the C1–2 posterior transarticular UCSS screw fixation combined with C1–2 posterior Gallie was performed, internal fixation with good and bone fusion (c, d)