Skip to main content

Advertisement

SpringerLink
Log in

Treatment for tuberculosis of the subaxial cervical spine: a systematic review

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

To systematically review the clinical manifestations and treatment outcomes of patients with subaxial cervical spinal tuberculosis (SCS-TB) and evaluate the current evidence for surgical or nonsurgical treatment.

Method

A systematic review was performed using the PubMed, ScienceDirect, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Studies published in English from January 2000 to December 2018 were included in the search. A reference lists search of relevant articles was also conducted for other potential references. The risk of bias was assessed with the 13-item criteria recommended by the Cochrane Back and Neck Group and the Methodological Index for Non-Randomized Studies.

Results

Fifteen articles were included with a total of 456 patients, of which only 1 study was randomized and fourteen were nonrandomized. The most common symptom reported was neck pain and stiffness, and the most common segment involved was C5. Of the 456 patients, 329 (72.1%) were treated surgically. Most experienced neurologic recovery after surgery. Instrumentation resulted in maintenance of the correction of alignment throughout the follow-up period. The use of radical debridement is still in debate.

Conclusions

Anti-TB therapy is necessary for all SCS-TB patients, including those underwent surgical management. For patients with neurological dysfunction, the surgical method with decompression and instrumentation could provide better cervical spinal alignment and stability. For adult, the radical debridement remains in debate, while for children, radical debridement may cause the development of progressive kyphosis during growth. Larger randomized comparative studies with longer follow-up times are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Zumla A, George A, Sharma V, Herbert N, Baroness MOI (2013) WHO’s 2013 global report on tuberculosis: successes, threats, and opportunities. Lancet 382(9907):1765–1767

    Article  PubMed  Google Scholar 

  2. Ferrer MF, Torres LG, Ramírez OA, Zarzuelo MR, Del Prado-González N (2012) Tuberculosis of the spine. A systematic review of case series. Int Orthop 36(2):221–231

    Article  Google Scholar 

  3. Polley P, Dunn R (2009) Noncontiguous spinal tuberculosis: incidence and management. EUR Spine J 18(8):1096–1101

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hsu LC, Leong JC (1984) Tuberculosis of the lower cervical spine (C2–C7). A report on 40 cases. J Bone Joint Surg Br 66(1):1–5

    Article  CAS  PubMed  Google Scholar 

  5. Garg B, Mehta N, Vatsya P (2020) Surgical strategy for correction of severe, rigid, post-tubercular cervical kyphosis: an experience of two cases. Spine Deform 8(4):801–807

    Article  PubMed  Google Scholar 

  6. Turgut M (2001) Spinal tuberculosis (Pott’s disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients. Neurosurg Rev 24(1):8–13

    Article  CAS  PubMed  Google Scholar 

  7. Hassan M (2003) Anterior plating for lower cervical spine tuberculosis. Int Orthop 27(2):73–77

    Article  CAS  PubMed  Google Scholar 

  8. Mao N, Shi Z, Ni H, Zhao Y, Tang H, Liu D et al (2013) Long-term outcomes of one-stage anterior debridement, bone grafting, and internal fixation for the treatment of lower cervical tuberculosis with kyphosis. Brit J Neurosurg 27(2):160–166

    Article  Google Scholar 

  9. Dunn RN, Ben HM (2018) Spinal tuberculosis: review of current management. Bone Joint J 100B(4):425–431

    Article  Google Scholar 

  10. Raja RA, Sheikh AU, Hussain M, Agani SA (2012) Early recovery and stabilisation with instrumentation in anterior cervical spine tuberculosis. J Ayub Med Coll Abbottabad 24(3–4):93–96

    CAS  PubMed  Google Scholar 

  11. Wang X, Luo C, Li W, Wu P, Pang X, Xu Z et al (2013) A practical therapeutic protocol for cervical tuberculosis. Eur J Trauma Emerg Surg 39(1):93–99

    Article  PubMed  Google Scholar 

  12. He M, Xu H, Zhao J, Wang Z (2014) Anterior debridement, decompression, bone grafting, and instrumentation for lower cervical spine tuberculosis. Spine J 14(4):619–627

    Article  PubMed  Google Scholar 

  13. Aggarwal A, Jain A, Jajoida N, Nand R, Kumar S, Kumar C (2014) Fate of kyphosis in tuberculosis of subaxial cervical spine treated non-operatively. Acta Orthop Belg 80(4):451–456

    PubMed  Google Scholar 

  14. Zeng H, Shen X, Luo C, Xu Z, Zhang Y, Liu Z et al (2016) 360-degree cervical spinal arthrodesis for treatment of pediatric cervical spinal tuberculosis with kyphosis. BMC Musculoskel Dis 17(1):175

    Article  Google Scholar 

  15. Fisahn C, Alonso F, Hasan GA, Tubbs RS, Dettori JR, Schildhauer TA et al (2017) Trends in spinal surgery for pott’s disease (2000–2016): an overview and bibliometric study. Global Spine Journal 7(8):821–828

    Article  PubMed  PubMed Central  Google Scholar 

  16. Narayan V, Mohammed N, Savardekar AR, Patra DP, Nanda A (2018) Tuberculous spondylolisthesis: a reappraisal of the clinicoradiologic spectrum and surgical treatment paradigm. World Neurosurg 114:361–367

    Article  PubMed  Google Scholar 

  17. Sharma A, Chhabra HS, Chabra T, Mahajan R, Batra S, Sangondimath G (2017) Demographics of tuberculosis of spine and factors affecting neurological improvement in patients suffering from tuberculosis of spine: a retrospective analysis of 312 cases. Spinal Cord 55(1):59–63

    Article  CAS  PubMed  Google Scholar 

  18. Yang S, Wang D, Xu J, Luo F, Wu W, Zhang Z (2019) A multicenter retrospective research of anterior debridement, decompression, bone grafting, and instrumentation for cervical tuberculosis. Neurol Res 41(12):1051–1058

    Article  CAS  PubMed  Google Scholar 

  19. Moon MS (2014) Tuberculosis of spine: current views in diagnosis and management. Asian Spine J 8(1):97–111

    Article  PubMed  PubMed Central  Google Scholar 

  20. Jain AK, Kumar J (2013) Tuberculosis of spine: neurological deficit. Eur Spine J 22(S4):624–633

    Article  PubMed  Google Scholar 

  21. Furlan AD, Malmivaara A, Chou R, Maher CG, Deyo RA, Schoene M et al (2015) 2015 Updated method guideline for systematic reviews in the Cochrane back and neck group. Spine 40(21):1660–1673

    Article  PubMed  Google Scholar 

  22. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. Anz J Surg 73(9):712–716

    Article  PubMed  Google Scholar 

  23. Huizing E, Schreve MA, de Vries J, Ferraresi R, Kum S, Unlu C (2019) Below-the-ankle angioplasty in patients with critical limb ischemia: a systematic review and meta-analysis. J Vasc Interv Radiol 30(9):1361–1368.e2

    Article  PubMed  Google Scholar 

  24. Zhang K, Crum RJ, Samuelsson K, Cadet E, Ayeni OR, de Sa D (2019) In-office needle arthroscopy: a systematic review of indications and clinical utility. Arthroscopy 35(9):2709–2721

    Article  PubMed  Google Scholar 

  25. Elsawaf A (2013) Outcome of surgical versus conservative management of cervical spine myelopathy secondary to cervical tuberculosis. Neurosurg Rev 36(4):621–628

    Article  PubMed  Google Scholar 

  26. Moorthy RK, Arunkumar MJ, Rajshekhar V (2004) Uninstrumented ventral surgery for subaxial cervical spine tuberculosis: clinical and radiological outcome. Brit J Neurosurg 18(6):584–589

    Article  CAS  Google Scholar 

  27. Moon MS, Moon JL, Kim SS, Moon YW (2007) Treatment of tuberculosis of the cervical spine: operative versus nonoperative. Clin Orthop Relat Res 460:67–77

    Article  PubMed  Google Scholar 

  28. Koptan W, ElMiligui Y, ElSharkawi M (2011) Single stage anterior reconstruction using titanium mesh cages in neglected kyphotic tuberculous spondylodiscitis of the cervical spine. Eur Spine J 20(2):308–313

    Article  PubMed  Google Scholar 

  29. Bhandari A, Garg RK, Malhotra HS, Verma R, Singh MK, Jain A et al (2014) Outcome assessment in conservatively managed patients with cervical spine tuberculosis. Spinal Cord 52(6):489–493

    Article  CAS  PubMed  Google Scholar 

  30. Zeng H, Liang Y, Wang X, Shen X, Luo C, Xu Z et al (2015) Halo traction, single-segment circumferential fixation treating cervical tubercular spondylitis with kyphosis. Clin Neurol Neurosur 138:59–65

    Article  Google Scholar 

  31. Zhaoyu Ba FPYH (2016) One-stage anterior radical debridement and reconstruction with titanium mesh combined with anti-tuberculosis for cervical spinal tuberculosis: 5–13 years follow up. Int J Clin Exp Med 3(9):6368–6372

    Google Scholar 

  32. Pan Z, Luo J, Yu L, Chen Y, Zhong J, Li Z et al (2017) Débridement and reconstruction improve postoperative sagittal alignment in kyphotic cervical spinal tuberculosis. Clin Orthop Relat Res 475(8):2084–2091

    Article  PubMed  PubMed Central  Google Scholar 

  33. Wu W, Li Z, Lin R, Zhang H, Lin J (2020) Anterior debridement, decompression, fusion and instrumentation for lower cervical spine tuberculosis. J Orthop Sci 25(3):400–404

    Article  PubMed  Google Scholar 

  34. Schulitz KP, Kothe R, Leong JC, Wehling P (1997) Growth changes of solidly fused kyphotic bloc after surgery for tuberculosis. Comparison of four procedures. Spine 22(10):1150–1155

    Article  CAS  PubMed  Google Scholar 

  35. Fountain SS, Hsu LC, Yau AC, Hodgson AR (1975) Progressive kyphosis following solid anterior spine fusion in children with tuberculosis of the spine. A long-term study. J Bone Joint Surg Am 57(8):1104–1107

    Article  CAS  PubMed  Google Scholar 

  36. Adhikari S, Basnyat B (2018) Extrapulmonary tuberculosis: a debilitating and often neglected public health problem. BMJ Case Rep 11(1):e226098

    Article  PubMed  PubMed Central  Google Scholar 

  37. Jain AK (2010) Tuberculosis of the spine. J Bone Jt Surg Br Vol 92B(7):905–913

    Article  Google Scholar 

  38. Govender S, Ramnarain A, Danaviah S (2007) Cervical spine tuberculosis in children. Clin Orthop Relat Res 460:78–85

    Article  CAS  PubMed  Google Scholar 

  39. Kamara E, Mehta S, Brust JCM, Jain AK (2012) Effect of delayed diagnosis on severity of Pott’s disease. Int Orthop 36(2):245–254

    Article  PubMed  PubMed Central  Google Scholar 

  40. Sm T (2002) General principles of osteoarticular tuberculosis. Clin Orthop Relat Res 398:11–19

    Article  Google Scholar 

  41. Liu Y, Chen Y, Yang L, Zhou X, Wang C, Qi M et al (2012) The surgical treatment and related management for post-tubercular kyphotic deformity of the cervical spine or the cervico-thoracic spine. Int Orthop 36(2):367–372

    Article  PubMed  PubMed Central  Google Scholar 

  42. Dai L, Jiang L, Wang Y, Jiang S (2010) Chemotherapy in anterior instrumentation for spinal tuberculosis: highlighting a 9-month three-drug regimen. World Neurosurg 73(5):560–564

    Article  PubMed  Google Scholar 

  43. Chandra SP, Singh A, Goyal N, Laythalling RK, Singh M, Kale SS et al (2013) Analysis of changing paradigms of management in 179 patients with spinal tuberculosis over a 12-year period and proposal of a new management algorithm. World Neurosurg 80(1–2):190–203

    Article  PubMed  Google Scholar 

  44. Obaid-ur-Rahman SA, Hussain T (2009) Anterior surgical interventions in spinal tuberculosis. J Coll Physicians Surg Pak 19(8):500–505

    CAS  PubMed  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Bo Yuan and Yin Zhao contributed equally to this work.

Authors and Affiliations

  1. Spine Center, Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People’s Republic of China

    Bo Yuan, Yin Zhao, Shengyuan Zhou, Zhiwei Wang, Xiongsheng Chen & Lianshun Jia

Authors
  1. Bo Yuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yin Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shengyuan Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhiwei Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiongsheng Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lianshun Jia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xiongsheng Chen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

Ethical approval was not taken.

Informed consent

Informed consent was not taken.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yuan, B., Zhao, Y., Zhou, S. et al. Treatment for tuberculosis of the subaxial cervical spine: a systematic review. Arch Orthop Trauma Surg 141, 1863–1876 (2021). https://doi.org/10.1007/s00402-020-03572-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-020-03572-7

Keywords

Search

Navigation