[Posterior debridement combined with atlantoaxial fusion to upper cervical tuberculosis].

Objective

To explore clinical results of posterior debridement combined with atlantoaxial fusion for upper cervical Tuberculosis.

Methods

From March 2007 to April 2012, 8 patients with upper cervical Tuberculosis underwent posterior debridement combined with atlantoaxial fusion in our hospital were selected for retrospective analysis. 3 cases were males and 5 females, aged 29-65 (43.5±13.2) years. According to the pedicle destruction, using different screws (pedicle screw or laminar screw) fixation.In the preoperative and final follow-up, Japanese Orthopaedic Association score (JOA) and neck disability index (NDI) were used to evaluate neurological function and calculate improvement rate JOA score. At final follow-up, clinical efficacy was evaluated by Odom's grade. situation of internal fixation, fusion of upper cervical were assessed by imaging examination. During follow-up, complications were documented and analyzed.

Results

Postoperatively 12 months, all bony fusion were achieved. Tuberculosis were reached clinical cure in 12-18 months. The JOA score increased from 10.5±2.0 preoperatively to 15.6 ±1.1 in final follow-up(P<0.05), and the NDI decreased from 29.9 ± 6.2 preoperatively to 8.6±1.6 (P<0.05). At last follow-up, according to Odom's standard, excellent were obtained in 6 cases (75.0%), good 1 cases (12.5%) and ordinary 1 case (12.5%). No severe complications was documented during follow-up.

Conclusions

The treatment of posterior debridement combine with atlantoaxial fusion, and structure grafting and local anti-Tuberculosis drug using intraoperative, not only could obtain reliable clinical efficacy, completely removal of lesions, but also obtain strong stability, which plays an important role in the treatment of cervical tuberculosis.