One-stage Surgical Management for Lower Cervical Spinal Tuberculosis by Anterior Debridement,Titanium Cage Fusion with Autograft and Instrumentation

Objective To evaluate the clinical efficacy of one-stage surgical management for lower cervical spinal tuberculosis by anterior debridement,titanium cage fusion with autograft and instrumentation.Methods From July 2008 to December 2011,15 patients suffering from lower cervical tuberculosis( 9 males and 6 females,aged 32 ~ 71 years,mean age 55 years)underwent one-stage anterior debridement,titanium cage fusion with autograft and instrumentation.The defect sites were C3 ~ 4in1 case,C4 ~ 5in 2 cases,C5 ~ 6in 4 cases,C6 ~ 7in 4 cases,C5 ~ 7in 4 cases.The mean preoperative Cobb angle was 35°( range22° ~ 46°).The preoperative Frankel grade: 2 Frankel B,3 Frankel C,8 Frankel D,2 Frankel E.Preoperative anti-tuberculosis treatment was given for 2 weeks at least,then the treatment lasted for 12 ~ 18 months postoperatively.Improvement of clinical symptoms and bone fusion were followed up.Results The operations were successfully completed without injury of blood vessels,spinal cord,esophagus and trachea.The incision healed with no complications such as sinus formation and wound infection.The mean follow-up was 30.6 months ranged from 20 to 60 months.The patients clinical symptoms and the neurological dysfunction had different degrees of improvement of 13 cases with neurological deficit,12 cases improved to Frankel E,1 case improved from Frankel B to Frankel D.The average Cobb angle of cervical spine was 2.6°( range 0° ~ 5°) at the final followup,which was significantly lower than preoperative one( P 0.01).After 3 ~ 5 months postoperatively,all cases were showed signs of bone fusion,and no recurrence or instrument failure was noted.Conclusion One-stage surgical management for lower cervical spinal tuberculosis by anterior debridement,titanium cage fusion with autograft and instrumentation is a safe and effective surgical method on the basis of standard anti-tuberculosis chemotherapy.