Surgical approaches to the treatment of cervicothoracic spinal tuberculosis

Objective:To explore surgical principles and evaluate surgical approaches to cervicothoracic spinal tuberculosis.Methods:Nine cases of cervicothoracic spinal tuberculosis in the recent three years were treated with different operative procedures.There were 2 cases with Frankel B,2 with C,3 with D,and 3 with E.One case was treated by the anterior approach of the lower cervical vertebrae with debridement,fusion,and plate-screw fixation,2 cases by the transsternal approach,4 cases by the upper transthoracic approach along the left side,2 cases by posterior debridement,posterolateral fusion,and transpedicular screw system fixation.The tissues and liquor puris debrided from focus were sent for pathology,Bacillus tuberculosis detection and culture,and drug sensitivity test.The patients received the anti-tuberculosis therapy according to the results of drug sensitivity tests for one year.Results:All the nine cases recovered from perioperation.The follow-up period ranged from 6 months to 2 years(mean,11 months).The paraplegina or neurological deficits were all recovered on average within 3 months for Frankel B or C and 1 month for Frankel D or E.All incisions got primary healing.No relapse occurred within the follow-up period.All cases were confirmed to be Bacillus tuberculosis infection by pathology.Bacillus tuberculosis was detected and cultured successfully in six cases.Three strains were drug resistant to one of anti-tuberculosis drugs but none multi-drug resistant.Conclusion:Different operative procedures should be selected to treat cervicothoracic spinal tuberculosis according to the degree and sites of lesions.Complete preoperative evaluation through X-Ray,CT or MRI and detailed assessment of the information of physiclal status and body figure are important.