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


  • Rieva Ermawan Department of Orthopaedic & Traumatology, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi General Hospital / Prof. Dr. R. Soeharso Orthopaedic Hospital, Surakarta
  • Pamudji Utomo Department of Orthopaedic & Traumatology, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi General Hospital / Prof. Dr. R. Soeharso Orthopaedic Hospital, Surakarta
  • Adhitya Indra Pradhana Department of Orthopaedic & Traumatology, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi General Hospital / Prof. Dr. R. Soeharso Orthopaedic Hospital, Surakarta
  • Umar Kharisma Islami


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:

Indonesian Journal of Medicine (2020), 05(02): 116-124


Bodapati PC, Vemula RCV, Mohammad AA, Mohan A (2017). Outcome and management of spinal tuberculosis according to severity at a tertiary referral center. Asian J Neurosurgery. 22(3): 441–446. doi: 10.4103/17935482.180924.

Cabraja M, Abbushi A, Kroppenstedt S, Woiciechowsky C (2010). Cages with fixation wings versus cages plus plating for cervical reconstruction after corpectomy is there any difference?. Cent. Eur. Neurosurgery. 71(2): 59–63. doi: 10.1055/s-0029-1246135.

Held MFG, Hoppe S, Laubscher M, Mears S, Dix Peek S, Zar HJ, Dunn RN (2017). Epidemiology of musculoskeletal tuberculosis in an area with high disease prevalence. Asian Spine J. 11(3): 405–411. doi: 10.4184/asj.2017.11.3.405.

Hou K, Yang H, Zhang L, Zhang X, Xiao S, Lu N (2015). Stepwise therapy for treating tuberculosis of the upper cervical spine: A retrospective study of 11 patients. Eur Neurol. 74(12): 100–106. doi: 10.1159/000437418.

Houston A, Macallan DC (2014). Extrapulmonary tuberculosis. Medicine (Baltimore). 42: 18–22. doi: 10.1016/j.mpmed.2013.10.008.

Issack PS, Boachie-Adjei O (2012). Surgical correction of kyphotic deformity in spinal tuberculosis. Int Orthop. 36(2): 353–357. doi: 10.1007/s00264-011-1292-9

Leonard MK, Blumberg HM (2017). Musculoskeletal Tuberculosis. Microbiol Spectr. 5(2). doi: 10.1128/microbialspec.TNMI7-0046-2017.

Moon MS, Kim SS, Lee BJ, Moon JL (2012). Spinal tuberculosis in children: Retrospective analysis of 124 patients. Indian J Orthop. 46(2): 150–158. doi: 10.4103/0019-5413.93676

Pan Z, Luo J, Yu L, Chen Y, Zhong J, Li Z, Zeng Z, et al. (2017). Debridement and reconstruction improve postoperative sagittal alignment in kyphotic cervical spinal tuberculosis. Clin Orthop. 475(8): 2084–2091. doi: 10.1007/s11999-017-5306-9

Perrini P, Gambacciani C, Martini C, Montemurro N, Lepori P (2015). Anterior cervical corpectomy for cervical spondylotic myelopathy: Reconstruction with expandable cylindrical cage versus iliac crest autograft. A retrospecttive study. Clin Neurol Neurosurg. 139: 258–263. doi: 10.1016/j.clineuro.2015.10.023.

Rasouli MR, Mirkoohi M, Vaccaro AR, Yarandi KK, Rahimi Movaghar V (2012). Spinal tuberculosis: Diagnosis and management. Asian Spine J. 6: 294–308. doi: 10.4184/asj.2012.6.4.294.

Shi T, Zhang Z, Dai F, Zhou Q, He Q, Luo F, Hou T, Xu J (2016). Retrospective study of 967 patients with spinal tuberculosis. Orthopedics. 39(5): e838-843. doi: 10.3928/0147744720160509-03.

Wang L, Liu L, Song Y, Pei F, Liu H (2014). Cervical tuberculosis associated with cervical pain and neurologic deficit: a case report and literature review. Spine J. Off. J. North Am. Spine Soc. 14: e13-18. doi: 10.1016/j.spinee.2013.10.055.

Zeng H, Shen X, Luo C, Xu Z, Zhang Y, Liu Z, Wang X, Cao Y (2016). 360 degree cervical spinal arthrodesis for treatment of pediatric cervical spinal tuberculosis with kyphosis. BMC Musculoskelet. Disord. 17: 175. doi: 10.11-86/s12891-016-1034-7

Zhang Z, Luo L, Zhou Q, Dai F, Sun D, Xu J (2016). The outcomes of chemotherapy only treatment on mild spinal tuberculosis. J Orthop Surg. 11(49): 1-8.