• Xiaobao Zou, Haozhi Yang, Su Ge, Yuyue Chen, Ling Ni, Shuang Zhang, Hong Xia, Zenghui Wu, and Xiang-Yang Ma.
• First School of Clinical Medicine, Southern Medical University, Guangzhou, China; Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China.
• World Neurosurg. 2020 Jun 1; 138: e275-e281.

BackgroundAtlantoaxial tuberculosis (TB) is rare in clinical practice, accounting for only about 0.3%-1% of spinal TB. An anterior-only surgical approach cannot provide strong fixation, whereas a posterior approach cannot achieve complete removal of lesions. A method combining anterior and posterior approaches to treat atlantoaxial TB is advisable. The aim of this study was to evaluate the effectiveness of anterior transoral débridement combined with posterior fixation and fusion for atlantoaxial TB.MethodsClinical data of 20 patients with atlantoaxial TB who underwent anterior transoral débridement combined with posterior fixation and fusion in our hospital were retrospectively analyzed. Antituberculosis drugs were administered for 18 months after surgery. Neurologic status, clinical symptoms, fusion, reduction, and complications were evaluated.ResultsSurgeries were performed successfully in all 20 cases with no injuries to spinal cord, nerves, or blood vessels. Clinical symptoms were relieved in all 20 patients (100%). Postoperative Japanese Orthopaedic Association score, occipitocervical visual analog scale score, and atlantodental interval were significantly improved (P < 0.05). Average follow-up duration was 33 months (range, 24-48 months). Bony fusion was achieved in all 20 cases. No serious complications were documented during follow-up.ConclusionsAnterior transoral débridement combined with posterior fixation and fusion is an effective treatment for atlantoaxial TB, achieving removal of lesions and stability.Copyright © 2020 Elsevier Inc. All rights reserved.

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