On-line version ISSN 2309-8309
Print version ISSN 1681-150X
SA orthop. j. vol.8 n.2 Pretoria Jan. 2009
PJ PolleyI; RN DunnII
IMBChB(UCT), FCOrth(SA); AOSpine Fellow, Spine Surgery Unit, Groote Schuur Hospital
IIMBChB(UCT), MMed(UCT)Orth, FCS(SA)Orth; Head of Spinal Services, Division of Orthopaedic Surgery, University of Cape Town
AIM: To review our experience and results of surgically managed cervical TB spondylitis.
MATERIAL AND METHODS: Eighteen consecutive cases of cervical TB spondylitis managed surgically by the senior author (RD) between 2001 and 2008 were identified. Of the 18, nine were males and nine females. The ages ranged from 2 to 59 years, with five patients younger than 10 years, and nine older than 10 and younger than 20 years of age.
Case notes and imaging were retrospectively reviewed.
Epidemiological data, surgical procedures and complications and neurological status were recorded both pre-operatively and at follow-up. The average follow-up was 12.5 months.
X-rays and MRI were assessed in terms of degree of involvement of the disease and sagittal plane deformity, and both correction and maintenance thereof.
RESULTS: The average length of history was 14 weeks and the most common presenting complaint was neck pain.
Blood results showed a consistently raised ESR (average 72), with a normal average white cell count of 8.7.
All patients with neurology recovered or improved, and the four non-walking patients became ambulant again.
Histology provided the most sensitive results with 14 out of 15 biopsies clearly positive and one suggestive (chronic inflammation). The five children under age 10 all had positive Mantoux skin tests.
All X-rays showed increased prevertebral soft tissue mass. Surgery was individualised to anterior, posterior, or both.
CONCLUSION: Cervical tuberculosis can be safely and successfully managed surgically; however, these patients are a heterogeneous group and their treatments should be individualised.
Anterior plating is effective in obtaining fusion but there is a risk of loss of correction especially for longer constructs. The use of low weight traction for deformity correction prior to surgery and Halo jackets post-operatively are useful management tools.
“Full text available only in PDF format”
2. Oxford Textbook of Medicine, Fourth Edition, Oxford University Press, pp 1 566 & 3 109. [ Links ]
3. Hsu LCS, Leong JCY. Tuberculosis of the lower cervical spine (C2 to C7). Journal of Bone and Joint Surgery (Br) 1984 Jan;66-B:1-5. [ Links ]
4. Moon MS, Moon JL, Kim SS, Moon YW. Treatment of tuberculosis of the cervical spine: Operative versus nonoperative. Clinical Orthopaedics and Related Research 2007 July;460:67-77. [ Links ]
5. Dhaval S, Sanjay M, Devi IB, Chandramouli BA, Bhavani SD. Management of craniovertebral junction tuberculosis. Surgical Neurology 2005;63:101-6. [ Links ]
6. Jain AK, Kumar S, Tuli SM. Tuberculosis of spine (C1 to D4) Spinal Cord 1999;37:362-9. [ Links ]
7. Govender S, Ramnarain AH, Danaviah S. Cervical spine tuberculosis in children. Clinical Orthopaedics and Related Research Jul 2007;460:78-85. [ Links ]
8. Chadha M, Agarwal A, Singh AP. Craniovertebral tuberculosis: a retrospective review of 13 cases managed conservatively Spine Jul 2007;32(15): 1629-34. [ Links ]
9. Fernyhough JC, White JI, LaRocca H. Fusion rates in multilevel cervical spondylosis comparing allograft fibula and autograft fibula in 126 patients. Spine 1991;16 (10 Suppl):S561-S564. [ Links ]
10. Vaccaro AR, et al. Early failure of long segment anterior cervical plate fixation. Journal of Spinal Disorders 1998;11:410-5. [ Links ]
11. Sasso RC, Ruggiero RA, Reilly TM, Hall PV. Early reconstruction failures after multilevel cervical corpectomy. Spine 2003;28:140-2. [ Links ]
Dr RN Dunn
Head of Spinal Services
Division of Orthopaedic Surgery
University of Cape Town
PO Box 30086
Tel: (021) 404-5108; Fax: 086 671 5294
Divisional Research Committee approval was obtained for this review. No financial benefits were derived by the authors.