title: Stepwise Therapy for Treating Tuberculosis of the Upper Cervical Spine: A Retrospective Study of 11 Patients.
abstract: OBJECTIVE
  Tuberculosis of the upper cervical spine is a rare occurrence with serious consequence, and its optimal treatment protocol remains inconclusive. This study aims at investigating the clinical characteristics and management outcomes of the stepwise therapy for different stages of tuberculosis of the upper cervical spine.
  
  
  METHODS
  We conducted a retrospective analysis of 11 patients with tuberculosis of the upper cervical spine who received anti-tuberculosis chemotherapy for 15 months. Two infants were treated by individualized chemotherapy, while 9 patients with retropharyngeal abscess were first treated with CT-guided percutaneous puncture, and the catheter was used to administer local chemotherapy. Two of these 9 patients continued to receive posterior instrumentation due to atlantoaxial subluxation. Patients were followed up clinically and radiologically for an average period of 60 months.
  
  
  RESULTS
  Two patients underwent catheter change due to catheter falling off and blockage, 2 patients had gastrointestinal side effects, and 2 patients had drug-induced hepatitis derived from the chemotherapy. Mean erythrocyte sedimentation rate was 10.27 mm/h (range 4-16 mm/h) and average visual analogue scale score was 2.55. A total of 11 cases underwent routine anti-tuberculosis chemotherapy for 15 months. 9 of 11 cases received supplementary surgical therapy, and all patients were cured at the final follow-up.
  
  
  CONCLUSIONS
  Standard anti-tuberculosis chemotherapy is the cornerstone of stepwise therapy for tuberculosis of the upper cervical spine. Local chemotherapy is effective and minimally invasive for patients with severe local symptoms without spinal cord compression. Just as in patients with atlantoaxial instability, open fixation and bone grafting are necessary.
authors: Pinggu Hospital of Capital Medical University, Beijing, China.
authors: Kedong
authors: K
authors: Hou
authors: Huadong
authors: H
authors: Yang
authors: Lin
authors: L
authors: Zhang
authors: Xifeng
authors: X
authors: Zhang
authors: Songhua
authors: S
authors: Xiao
authors: Ning
authors: N
authors: Lu
mesh_terms: D000995:Antitubercular Agents / Q000008:administration & dosage / Q000009:adverse effects; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000382:microbiology* / Q000473:pathology / Q000628:therapy*; D013123:Spinal Fusion; D014376:Tuberculosis / Q000473:pathology / Q000628:therapy*
chemical_list: D000995:Antitubercular Agents