Functional outcomes in the management of cervicothoracic junction tuberculosis

Abstract

Background: We analyzed the clinical and radiological parameters influencing functional outcomes and neurological recovery in patients with cervicothoracic junctional tuberculosis (TB). Methods: This was a retrospective analysis of 16 cases of cervicothoracic junction (CTJ) spinal TB; 11 patients were managed operatively, while five were managed conservatively. Patients’ outcomes were assessed at 1 month, 1 year, and yearly thereafter and included an analysis of multiple outcome scores, various radiographic parameters, and sensitivity or resistance to anti-tubercular therapy. Results: Patients averaged 25.94 years of age, and typically had three-level vertebral involvement. They were followed for a mean duration of 24 months, and the duration of anti-tubercular therapy averaged 17 months. Patients demonstrated clinical improvement on Japanese Orthopedic Association score and Neck disability index (P < 0.005) starting from 1 month following initiation of treatment which continued in subsequent follow-up, along with change in radiological parameters consisting of mean segmental kyphotic angle from 18.98° to 15.13°, C2–C7 SVA from 16.13 mm to 22.61 mm, T1 slope from 22.80° to 14.66°, thoracic inlet angle from 75.35° to 63.25°, neck tilt from 51.81° to 48.33°, and cervical lordosis from 4.66° to −0.44° (P > 0.05) at the end of 1 year. Conclusion: Tuberculous affection of the dynamic CTJ is a challenging scenario in clinical practice and its management involves consideration of disease extent, neurological status, and effort toward restoration of normal alignment of spine in sagittal and coronal plane to get favorable clinical outcomes.

The Incidence, Changes and Treatments of Cervical Deformity After Infection and Inflammation

“…At the same time, there was no significant difference in the C2-7 sagittal vertical axis (SVA) (16.10 ± 7.74 mm vs. 16.18 ± 13.22 mm) between them. 49 The whole sagittal alignment changes in patients with CSTB kyphosis who underwent staged combined posterioranterior surgery were reported by Luan et al 50 : The SVA (35.19 ± 10.69 mm) and coronal balance distance (22.58 ± 7.59 mm) was greater than the normal values, indicating a coronal and sagittal imbalance. Surgery can improve the cervical spine sagittal alignment; the C0-2, C2-7, and local Cobb angles, T1 slope, C2-7 SVA, and CGH-C7 SVA were corrected remarkably after surgery.…”