Fate of kyphosis in tuberculosis of subaxial cervical spine treated non-operatively


Published online: Dec 27 2014

Aditya AGGARWAL, Anuj JAIN, Nitesh JAJOIDA, Raj NAND, Sudhir KUMAR, Chandra KUMAR

From University College of Medical Sciences (UCMS) and assoc. Guru Teg Bahadur (GTB) Hospital, Delhi, India

Abstract

Study design : Retrospective study Objective : Observation of post treatment kyphotic angle in patient of cervical spine tuberculosis managed non operatively Background : The incidence of tuberculosis of cervical spine is about 6-9%. The most dreaded complications of spinal tuberculosis are neural involvement and spinal deformity. Due to destruction of the vertebra tuberculosis of spine usually leads to variable amount of kyphotic deformity. Methods : We retrospectively reviewed 13 patients with clinico-radiological diagnosis of cervical spine tuberculosis managed in our centre between 2004 to 2011. The patients were started on antitubercular therapy. Crutchfield tongs traction was applied 8 to 12 weeks followed by mobilization with four post collar. The kyphotic angles were measured by radiograph at presentation and last available follow up radiograph. Observations : The mean age of the patients was 20 years. C3-C4 vertebra was the most commonly involved area. One patient had single vertebra involvement, five patients had two vertebrae involvement, five patients had three vertebrae involvement and two patients had four vertebrae involvement. The average number of vertebrae involved was 2.6 vertebrae. 9 out of 13 patients had neural deficit at the time of initial presentation. The mean follow up was 21.23 months (12 to 42 months). All patients responded favorably and had neural recovery. At final follow up, 10 out of 13 patients had improvement in kyphotic angle, two patients had deterioration of kyphotic angle and one patient had no change in kyphotic angle. Only one patient had significant deterioration in kyphotic angle. Conclusion : Non operative treatment of cervical spine tuberculosis by initial traction and antitubercular therapy improves the pretreatment deformity irrespective of the number of vertebra involved.