CORRInsights®: Débridement and Reconstruction Improve Postoperative Sagittal Alignment in Kyphotic Cervical Spinal Tuberculosis

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Although tuberculosis of the spine is an uncommon condition in most developed countries, the disease remains common in many underdeveloped regions. Patients with this condition, particularly in the early stages, generally are treated with antituberculosis drugs, spinal orthotics for improved stability, and improved nutrition [1, 4, 6]. However, some patients develop neurological deficits, epidural or paravertebral abscesses, spinal instability, or considerable deformity of the spine. Generally, these patients are treated with surgical débridement and stabilization [1, 6].
The surgical approach for débridement and stabilization varies depending upon the anatomic portion of the spine affected, the magnitude of the deformity, and the surgeon's preferences. In the current study, Pan and colleagues performed a retrospective study of patients with cervical spinal tuberculosis causing kyphosis who underwent surgical débridement and reconstruction. The authors reported four important findings: (1) All patients were successfully treated and showed bone fusion on CT scans, (2) anterior débridement and reconstruction is successful in improving cervical spine realignment in patients with kyphosis due to tuberculosis, (3) use of titanium mesh cage and instrumentation is safe in these patients, and (4) patients reported improvement in the Neck Disability Index (NDI) after surgery that correlated best with C2 to C7 sagittal vertical axis.
Pan and colleagues suggest treating patients with kyphosis greater than 0° with surgical treatment regardless of the presence of neurological deficits or spinal cord compression. While a good treatment option, the selection of any kyphosis greater than 0° is somewhat arbitrary and the amount of kyphosis that should indicate surgical débridement and realignment has yet to be clearly defined.
Various parameters are used to assess appropriate cervical balance in the sagittal plane. The mean cervical lordosis from C2 to C7 is approximately 10° [2, 3, 9]. However, unlike in the lumbar spine, we do not know the ideal postoperative cervical lordosis that should be achieved in order to have a good patient-reported outcome as a strong correlation between cervical lordosis or kyphosis and health-related quality-of-life outcomes has not been found. Interestingly, studies have found a better correlation between C2 to C7 sagittal vertical axis and health-related quality-of-life measures [2, 5, 9]. A C2 to C7 sagittal vertical axis of greater than 4 cm has been correlated with worse NDI scores [2, 9].

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