The role of anterior and posterior approaches with circumferential reconstruction without any anterior instrumentation in extended multilevel cervical spinal tuberculosis

To evaluate the clinical efficacy and feasibility of 11 patients with extended multilevel (>= 3 levels) cervical spinal tuberculosis treated by combined anterior debridement, decompression and long allograft bone and posterior instrumentation and posterior-lateral fusion. Retrospective review of data on eleven patients who suffered from extended (>= 3 levels) multilevel cervical spinal tuberculosis (EMCST) admitted to our hospital between January 2006 and December 2012. All of them were treated by anterior debridement, corpectomy, decompression and peg-in-hole allograft bone without anterior instrumentation combined with posterior lateral mass screw fixation and posterior-lateral fusion. Of which, 3 patients were securely added with laminectomy in consideration of anterior severe compression. Anteroposterior/ lateral plain films and computed tomographic images were used to determined sagittal balance and bone fusion. The clinical efficacy was evaluated using statistical analysis based on the materials about the visual analogue scale (VAS) scores of pain, neurological status and erythrocyte sedimentation rate (ESR), which were collected at certain time. The average follow-up period was 33.9 +/- 6.3 months (24-43 months). In the 11 cases, no postoperative complications related to instrumentation occurred and neurologic function was improved in various degrees. The average pretreatment ESR was 51.7 +/- 14.1 mm/h (30-83 mm/h), which got normal (8.1 +/- 1.6 mm/h) within 3 months in all patients. The average preoperative VAS was 6.6 +/- 1.1, which decreased to 0.5 +/- 0.69 postoperatively. All patients got bony fusion within 6-9 months after surgery. In conclusions, anterior debridement, corpectomy, decompression and peg-in-hole allograft fusion combined with posterior instrumentation and posterior-lateral fusion with or without laminectomy can be an effective treatment method for the treatment of extended multilevel cervical spine tuberculosis.