Outcome of surgical versus conservative management of cervical spine myelopathy secondary to cervical tuberculosis

摘要

Cervical spine tuberculosis is a rare infectious disease that is not yet discussed well regarding the optimal method of its management. This is a prospective study of a total of 29 patients with cervical spine tuberculosis with a mean follow-up of 14 months (range, 10-21); they were classified randomly into two groups: group I, patients who underwent anterior cervical decompression and fixation and followed by the anti-tuberculous medications (16 patients) and group II, patients who had conservative anti-tuberculous medications only without surgical intervention (13 patients). All patients had complete clinical assessments using Nurick scale and the modified Japanese Orthopaedic Association score for myelopathy and the visual analogue scale for assessment of cervical pain. We had also neuro-radiographic assessment (cervical spine X-ray and MRI) at the first presentation and at 3, 6, and 12 months later. At final follow-up, significant neurological improvement was demonstrated in both management approaches, more obvious in the surgical group. Cervical pain showed a statistically significant improvement (P < 0.05) in surgical group rather than in conservatively treated group. In the surgical group, the mean Cobb angle showed a significant change from a preoperative mean of -3.1 ± 1.6 to postoperative mean of 16.6 ± 5.4, significantly correlated to the improvement of cervical pain (P = 0.004), while it was changed from a mean of -0.8 ± 2.2 to a mean of 9.2 ± 3.8 1 year after starting of medical treatment in group II. In spite of the conservative trend in the management of Pott's disease, surgical management of cervical spine myelopathy secondary to cervical tuberculosis could be the optimal treatment even in an early stage of the disease.