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Outcome of treatment of cervical spine tuberculosis at the King George V hospital spine unit
Abstract
Background: Tuberculosis of the cervical spine is uncommon, constituting 3-9% of all cases of tuberculous spondylitis.
Objective: To document the results of treatment of cervical spine tuberculosis at the King George Spine Unit.
Setting: King George V Hospital Spine Unit, Durban, South Africa.
Methodology: This was a review of files of patients treated for cervical spine tuberculosis over a period of 20 years (December 1987 to August 2008).
Results: Sixty cases of cervical spine tuberculosis were identified over the study period. The sub-axial spine was affected in 86% of cases. Non-contiguous extra-cervical spinal lesions occurred in 24% of cases. Pulmonary tuberculosis was found in 13% of cases. Other areas of the musculoskeletal system were involved in 7% of cases. The results of treatment were good with 28 of 30 cases (93%) treated by anterior decompression, grafting and interbody fusion showing incorporation of the graft. There was improvement in neurological deficits too. Adjacent segment degeneration was seen in 15 of 35 cases (43%). Graft slippage occurred in four cases (10%). Pancervical ankylosis was seen in three cases (9%) and was symptomatic in one (3%) of these cases. Other complications included esophageal injury, graft fracture, screw loosening, screw malposition and plate fixation failure (2.5% in each case).
Conclusion: The results of treatment of cervical spine tuberculosis are good. The most common complication is adjacent segment degeneration, which when severe, presents as pancervical ankylosis. This needs long-term follow-up for clinical features of cervical stenosis. Graft slippage is the second most common complication and is prevented by plate fixation.
Objective: To document the results of treatment of cervical spine tuberculosis at the King George Spine Unit.
Setting: King George V Hospital Spine Unit, Durban, South Africa.
Methodology: This was a review of files of patients treated for cervical spine tuberculosis over a period of 20 years (December 1987 to August 2008).
Results: Sixty cases of cervical spine tuberculosis were identified over the study period. The sub-axial spine was affected in 86% of cases. Non-contiguous extra-cervical spinal lesions occurred in 24% of cases. Pulmonary tuberculosis was found in 13% of cases. Other areas of the musculoskeletal system were involved in 7% of cases. The results of treatment were good with 28 of 30 cases (93%) treated by anterior decompression, grafting and interbody fusion showing incorporation of the graft. There was improvement in neurological deficits too. Adjacent segment degeneration was seen in 15 of 35 cases (43%). Graft slippage occurred in four cases (10%). Pancervical ankylosis was seen in three cases (9%) and was symptomatic in one (3%) of these cases. Other complications included esophageal injury, graft fracture, screw loosening, screw malposition and plate fixation failure (2.5% in each case).
Conclusion: The results of treatment of cervical spine tuberculosis are good. The most common complication is adjacent segment degeneration, which when severe, presents as pancervical ankylosis. This needs long-term follow-up for clinical features of cervical stenosis. Graft slippage is the second most common complication and is prevented by plate fixation.
