Cervical spinal tuberculosis: a preliminary study of clinical diagnosis and management
Bunmaprasert, T.; Dongsang, K.
Journal of the Medical Association of Thailand 98(1): 33-38
2015
ISSN/ISBN: 0125-2208 PMID: 25775729 Document Number: 16277
Cervical involvement in spinal tuberculosis is rare; however delayed diagnosis and treatment may result in massive, irreversible neurological deterioration. The purpose of this study is to report on a strategy for clinical diagnosis and management of cervical spinal tuberculosis. Eighteen patients (13 males and 5 females) during 1998-2013 were retrospectively reviewed at Chiang Mai University Hospital. The patients had a mean age of 51.4 years (range 37-68 years). History, examination, radiographs, MRI and tissue sampling were used in diagnosis. Most of the patients were given antituberculous therapy (ATT) and underwent surgical management. The mean follow-up period was 12.8 months. Axial neckpain, quadriparesis, spastic gait and hand clumsiness were the predominant symptoms. Disc narrowing, endplate destruction andparaspinal soft tissue swelling were the prominent radiographic findings. MRI found Gadolinium enhancement of prevertebral soft tissue, T2 hypersignal of the intervertebral discs, intraosseous T2 hypersignal at the vertebral body, and disc fragmentation. Thirteen patients underwent single-stage anterior debridement with fusion. Three patients underwent posterior fusion alone. Axial neck pain improved in all patients. Nurick's disability index and fusion rate improved in 70% of the patients after conservative and surgical treatment. Cervical spinal tuberculosis should be suspected in endemic patients with severe neck pain and progressive neurological deficit. Histopathology is the gold standard of tuberculosis diagnosis. Anti-tuberculosis drugs should be continued for at least 12 months. Radical anterior debridement and instrumented fusion has demonstrated favorable results. The posterior approach is an alternative treatment in patients when the anterior approach cannot be performed or as part of second-stage surgery.
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