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Two-Stage Reconstruction Surgery on Cervical Deformity Caused by Spondylitis TB

Rieva Ermawan, Pamudji Utomo, Adhitya Indra Pradhana, Umar Kharisma Islami

Abstract

Background: Of all form of spinal tuberculo­sis (TB), cervical involvement is immensely rare and merely found in 3-5% of all cases. Kyphotic deformity in spondylitis TB was caused by ver­tebral destruction in the anterior segment due to infection that lead to hyperemia, bone marrow edema, and osteoporosis. Treatment of spinal TB was divided into two sections which run simultaneously, medicament and surgery. The use of cage for spinal surgery has shown its effectivity in supporting the anterior segment of vertebrae and providing long term stability. The purpose of this study was to compare functional out­come of two patients with cervical deformity caused by spondylitis TB that underwent two-stage reconstruction surgery with expandable and non-expandable cage. 

Case Presentation: Two patients were re­ported with cervical deformity caused by spon­dylitis TB in Orthopedic Hospital Prof. Dr. R. Soeharso, Surakarta. Both patients had their neurological status, Cobb angle, decompres­s­ion effects and post-operative fusion rate assessed. The patients were diagnosed with cervical deformity due to spondylitis TB showing the involvement of C4-5 in the first patient and C3-5 in the second one. Both underwent two-stage reconstruction surgery and were evaluated right after. There was no decadence in their post-operative neurological function. In the first patient, pre-operative Cobb angle was 44oand becoming 18o post-operatively. The pre-operative Cobb angle of the second patient was 14o and becoming 3o post-operatively.

Results: Assessment of post-operative decom­pression effects and fusion rate were carried out by CT scan and both patients showed a favorable result even when they both were given a different cage. Although both cages had their own advantages based on surgical consi­deration, we prefer to used expandable cage due to minimal dissection needed.

Conclusion: Two-stage reconstruction surge­ry using whether expandable or non-expand­able cage to treat cervical deformity caused by Spondylitis TB gave equally satisfactory out­come.

Keywords: Spondylitis, tuberculosis, cervical deformity

Correspondence: Adhitya Indra Pradhana. Prof. Dr. R. Soeharso Orthopaedic Hospital. Jl. Jenderal Ahmad Yani, Surakarta 57162, Central Java, Indonesia. Email: adhityaindrapradhana@gmail.com

Indonesian Journal of Medicine (2020), 05(02): 116-124
https://doi.org/10.26911/theijmed.2020.05.02.04

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