Cervicodorsal spine tuberculosis-- surgical approach

Area of Science:

• Spinal Surgery
• Infectious Diseases
• Orthopedics

Background:

• Tuberculosis (TB) of the cervicothoracic (CT) junction is an uncommon (5% of spinal TB) and surgically challenging condition due to its deep anatomical location.
• The deep location, protected by the sternum anteriorly and scapula posteriorly, complicates surgical access.

Purpose of the Study:

• To present the treatment outcomes of 7 consecutively treated cases of CT junction TB.
• To discuss the rationale behind choosing specific surgical approaches for CT junction TB.

Main Methods:

• The study included 7 newly diagnosed cases of CT junction TB.
• Surgical planning involved plain radiographs and CT/MRI with sagittal reconstruction, utilizing the suprasternal notch as a landmark to determine the optimal anterior surgical approach (anterior cervical with or without manubriotomy/sternotomy).
• All patients underwent anterior decompression, kyphotic deformity correction, and instrumented stabilization.

Main Results:

• Seven female patients with a mean age of 20 years (range 9-45) were treated.
• Vertebral involvement varied, with 3 cases affecting 2 vertebrae, 2 cases affecting 3 vertebrae, and 2 cases affecting more than 3 vertebrae.
• Six patients showed initial neural recovery within 3 weeks, with near-complete recovery by 3 months; one patient had partial recovery. All patients completed 12 months of anti-tuberculosis therapy (ATT).

Conclusions:

• CT junction TB often presents with severe kyphotic deformity and neurological deficits, necessitating surgical intervention.
• Anterior decompression, corpectomy, deformity correction, grafting, and stabilization are key components of treatment.
• The Karikari method aids in determining the need for manubriotomy for adequate decompression, especially in pan-vertebral disease requiring 360° stabilization.