Anterior Transoral Débridement Combined with Posterior Fixation and Fusion for Atlantoaxial Tuberculosis

Abstract

Background: Atlantoaxial tuberculosis (TB) is rare in clinical practice, accounting for only about 0.3%-1% of spinal TB. An anterior-only surgical approach cannot provide strong fixation, whereas a posterior approach cannot achieve complete removal of lesions. A method combining anterior and posterior approaches to treat atlantoaxial TB is advisable. The aim of this study was to evaluate the effectiveness of anterior transoral débridement combined with posterior fixation and fusion for atlantoaxial TB.

Methods: Clinical data of 20 patients with atlantoaxial TB who underwent anterior transoral débridement combined with posterior fixation and fusion in our hospital were retrospectively analyzed. Antituberculosis drugs were administered for 18 months after surgery. Neurologic status, clinical symptoms, fusion, reduction, and complications were evaluated.

Results: Surgeries were performed successfully in all 20 cases with no injuries to spinal cord, nerves, or blood vessels. Clinical symptoms were relieved in all 20 patients (100%). Postoperative Japanese Orthopaedic Association score, occipitocervical visual analog scale score, and atlantodental interval were significantly improved (P < 0.05). Average follow-up duration was 33 months (range, 24-48 months). Bony fusion was achieved in all 20 cases. No serious complications were documented during follow-up.

Conclusions: Anterior transoral débridement combined with posterior fixation and fusion is an effective treatment for atlantoaxial TB, achieving removal of lesions and stability.

Keywords: Anterior transoral débridement; Atlantoaxial joint; Posterior fixation and fusion; Tuberculosis.