Anterior Cervical Retropharyngeal Debridement Combined With Occipital Cervical Fusion to Upper Cervical Tuberculosis.

STUDY DESIGN A retrospective analysis of 11 cases. OBJECTIVE The aim of the study was to evaluate the effectiveness of anterior cervical and retropharyngeal debridement combined with posterior occipital-cervical fusion in treatment of upper cervical spinal tuberculosis. SUMMARY OF BACKGROUND DATA The anterior approach simply could not provide strong fixation whereas the posterior treatment could not clear up the lesions completely. The method combining anterior and posterior approaches to treat the upper cervical tuberculosis is advisable. METHODS The clinical data of 11 patients with upper cervical tuberculosis who underwent an upper cervical operation in our hospital were retrospectively analyzed. All 11 patients underwent the surgery of anterior cervical and retropharyngeal approaches to debridement, and then, according to the different degrees of patient pedicle destruction and deformity, different occipitocervical approaches were used (either through pedicle screw or laminar screw fixation). After surgery, antituberculosis drugs were administered for 18 months. During the follow-up, neurological function, clinical symptoms, fusion, reducible degree, and complications were all evaluated and documented. RESULTS Surgeries for 11 patients were performed successfully; anatomical reduction was achieved in nine cases, bony fusion was achieved in all 11 patients, and all cases with tuberculosis were clinically cured in the 18 months after the operation. The Japanese Orthopaedic Association score increased from 8.4 ± 1.3 preoperative to 15.0 ± 1.3 in the last follow-up (P < 0.05). The occipitocervical visual analog scale decreased from 6.7 ± 0.6 preoperative to 0.6 ± 0.6 at the last follow-up (P < 0.05). No serious complications were documented during follow-up. CONCLUSION The approach of anterior cervical and retropharyngeal debridement combined with posterior occipitocervical fusion has been proved to be an effective treatment of upper cervical tuberculosis, which plays an important role in removing the lesions, restoring stability, and anatomical reduction. LEVEL OF EVIDENCE 4.