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 ±â€Š1.3 preoperative to 15.0 ±â€Š1.3 in the last follow-up (P < 0.05). The occipitocervical visual analog scale decreased from 6.7 ±â€Š0.6 preoperative to 0.6 ±â€Š0.6 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.

Pus and free bone flaps.

OBJECT: The goal of this investigation is to describe the results of a vigorous attempt to preserve contaminated free bone flaps and avoid the problems associated with the traditional and common practice of discarding the flap, administering a course of antibiotics, and after several months, performing a cranioplasty. METHODS: Patients with clearly contaminated, free cranial bone flaps, including so-called high risk cases, were treated by meticulous debridement of the surgical bed, scrubbing, soaking, and then replacing the bone flap in its normal position, and administering a course of intravenous antibiotics. RESULTS: Fourteen patients with contaminated avascular cranial bone flaps were treated using this technique. All bone flaps were able to be preserved. Conclusions Patients with bacteriologically contaminated, free bone flaps can be treated successfully without discarding the flaps. Success is dependent upon aggressive surgical debridement and persistence.

Unusual presentations of craniovertebral junction tuberculosis: a report of 2 cases and literature review.

BACKGROUND: CVJ tuberculosis is a described entity requiring challenging ways of management. Severe neck pain, causing restricted neck movements and torticollis, is a characteristic presentation of neurologically asymptomatic suboccipital Pott's disease. CASE DESCRIPTION: Two patients with unusual CVJ tuberculosis form the basis for the present communication. The first patient presented with tubercular otitis media, causing progressive erosion of the petrous part of temporal bone, and destruction of the occipital condyle, along with the lateral mass of atlas, leading to CVJ instability. This is a first report of such a presentation, according to our knowledge. Detailed bony architectural destruction demonstrable on CT scan has been described. The second patient, with CVJ tuberculosis, presented with skull base syndrome and with multiple cranial nerve palsies. Both patients were managed without surgical intervention and showed clinical and radiological recovery. CONCLUSION: In such patients with unusual clinical presentations, histopathologic examination is necessary to arrive at a correct diagnosis. The management of patients with tubercular involvement of CVJ remains controversial. In the present communication, both the patients were managed successfully with full dose of antitubercular drugs and immobilization.