Functional outcomes in the management of cervicothoracic junction tuberculosis

Abstract

Background: We analyzed the clinical and radiological parameters influencing functional outcomes and neurological recovery in patients with cervicothoracic junctional tuberculosis (TB).

Methods: This was a retrospective analysis of 16 cases of cervicothoracic junction (CTJ) spinal TB; 11 patients were managed operatively, while five were managed conservatively. Patients' outcomes were assessed at 1 month, 1 year, and yearly thereafter and included an analysis of multiple outcome scores, various radiographic parameters, and sensitivity or resistance to anti-tubercular therapy.

Results: Patients averaged 25.94 years of age, and typically had three-level vertebral involvement. They were followed for a mean duration of 24 months, and the duration of anti-tubercular therapy averaged 17 months. Patients demonstrated clinical improvement on Japanese Orthopedic Association score and Neck disability index (P < 0.005) starting from 1 month following initiation of treatment which continued in subsequent follow-up, along with change in radiological parameters consisting of mean segmental kyphotic angle from 18.98° to 15.13°, C2-C7 SVA from 16.13 mm to 22.61 mm, T1 slope from 22.80° to 14.66°, thoracic inlet angle from 75.35° to 63.25°, neck tilt from 51.81° to 48.33°, and cervical lordosis from 4.66° to -0.44° (P > 0.05) at the end of 1 year.

Conclusion: Tuberculous affection of the dynamic CTJ is a challenging scenario in clinical practice and its management involves consideration of disease extent, neurological status, and effort toward restoration of normal alignment of spine in sagittal and coronal plane to get favorable clinical outcomes.

Keywords: ASIA; Cervical sagittal alignment; Cervicothoracic junction; Neck disability index; Thoracic inlet measurement; Tuberculosis.

Figure 1:

(a) Radiograph showing CTJ kyphosis with hyperlordosis of the cervical spine, (b) anterior cervical plate in situ with caudally directed inferior screws, (c) anterior cervical plate in situ with cephalad directed inferior screws depicting increased kyphosis due to unabated posterior column growth, and (d) correction of kyphosis with additional posterior instrumentation.

Figure 2:

(a) MRI showing tubercular spondylodiscitis of the CTJ with cord compression and (b) lateral radiograph showing mesh cage in situ spanning C6-T1 levels.

Figure 3:

(a) MR sagittal T2W imaging showing CTJ and sternal tuberculosis with prevertebral abscess and (b) resolution of tubercular focus post anti-tubercular therapy for 9 months.