Surgical Management and Outcome of Tuberculous Atlantoaxial Dislocation: A 15-year Experience

Abstract

The transcervical retropharyngeal approach to the craniovertebral junction provides direct access to the lesion and avoids the potential bacterial contamination of the oral and pharyngeal cavity. It also prevents the development of persistent fistulae. Posterior stabilization should be performed directly after anterior neural decompression, while the patient remains under anesthesia, to prevent neurological deterioration before subsequent posterior fixation. This technique also is helpful for early mobilization of patients. The aim of surgical treatment should be to obtain biopsy tissue and to perform radical excision of epidural granulation tissue/abscess and infected bone using microsurgical technique. Antituberculous medication must be continued for 18 months with four drug regimens, and continuous monitoring of drug toxicity should be performed throughout the course of treatment.

Posterior Instrumentation Surgery for Craniocervical Junction Instabilities: an Update

“…In several series in India, tuberculous atlantoaxial dislocation was frequently associated with anterior compression of the brainstem from massive tuberculous granuloma, necessitating removal of the granuloma via an anterior approach followed by a posterior atlantoaxial fixation, or an occipitocervical fixation for those in whom the posterior arch of the atlas was destroyed. 2,44,76) Neurological recovery and significant pain relief was achieved in most cases. 2,44,76) Metastatic tumor rarely involves the CCJ, but can cause progressive instability in the region.…”

“…2,44,76) Neurological recovery and significant pain relief was achieved in most cases. 2,44,76) Metastatic tumor rarely involves the CCJ, but can cause progressive instability in the region. Osteolytic destruction of atlantoaxial spine elements can result in pathological fractures.…”

Pattern Of Spinal Tuberculosis At Liaquat University Hospital, Hyderabad/Jamshoro

“…25 However, if severe bone involvement accompanied by cord or root compression is present, surgical treatment is the only remedy. [26][27][28] Judicial combination of conservative therapy and surgical decompression has also been advocated by Tulsi, et al 18 . In their series of 100 cases, 50% required surgical treatment.…”

A large tuberculosis abscess causing spinal cord compression of the cervico-thoracic region in a young child

“…Only very few have compared the results of operative and non-operative treatment of TB of the cervical spine in children and adults and the different patterns of healing between the two age groups [17][18][19][20][21][22][23]. The diagnostic difficulty arises because most of the patients with TB of the cervical spine do not show the classic constitutional symptoms such as fever, weight loss, and loss of appetite [24].…”