The Results of Nonoperative Treatment of Craniovertebral Junction Tuberculosis: A Review of Twenty-six Cases

Arora, Sumit; Sabat, Dhananjaya; Maini, Lalit; Sural, Sumit; Kumar, Vinod; Gautam, VK; Gupta, Ajay Kumar; Dhal, Anil

doi:10.2106/jbjs.j.00634

Cited by 41 publications

(44 citation statements)

References 18 publications

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“…On one side there are a lot of case descriptions and several case series with more or less cases, all of them with some recommendations regarding classification [19], the establishment of diagnosis and the value of biopsy [13,16,[18][19][20][21]; furthermore, their recommendations are also related to treatment modalities [15,16] and to indications for treatment. Since craniocervical junction tuberculosis carries the risk of secondary instability and severe neuraxis compression [5], sometimes in the sense of severe bulbo-medullary complications [2] with painful torticollis, dysphagia and tetraparesis, early diagnosis is of utmost importance. In rare cases of patients with neurological deficit due to craniocervical junction tuberculosis, a hemiplegia or a monoplegia may occur.…”

Section: Discussionmentioning

confidence: 99%

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Tuberculosis of the craniovertebral junction

et al. 2012

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Purpose Tuberculosis (TB) of craniovertebral junction (CVJ) occurs in 1-5 % of cases of TB spondylitis. This can be a life-threatening condition due to mass effect of infective process or resultant instability. Surgical indications for TB of CVJ are not clear from literature. Methods We have reviewed all the patients with TB of CVJ admitted at our center between 2005 and 2010. Results There were 15 patients including 10 males and 5 females. Average age was 38 years and average duration of symptoms was 8 months. All patients were started on multidrug antituberculous chemotherapy and skull traction. Those patients who failed to respond in 4-6 weeks and had persistent instability or neurological deficit were offered surgery. Rest was treated conservatively by immobilisation or traction. All five patients who were surgically treated had occipitocervical fusion (OCF) with titanium screws and plate/rod construct combined with posterior decompression if needed. Only one patient needed anterior surgery in addition to OCF at a later stage. All patients improved neurologically whether they were treated surgically or conservatively. Only difference was that surgically treated patients had earlier pain relief, mobilisation, neurological improvement and lesser complications. Conclusion We recommend that all patients with TB of CVJ with instability and neurological compromise, who fail to respond to 4-6 weeks of antituberculous chemotherapy and skull traction should be offered occipitocervical fusion with or without posterior decompression. Anterior surgery will be needed only in those few cases who do not improve neurologically after OCF.

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Section: Discussionmentioning

confidence: 99%

“…Some people recommend conservative treatment only [1,2,5,11,22], others recommend surgery in all patients [3,6,8,23]. Some have shifted their management protocols from surgical to conservative and vice versa.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis of the craniovertebral junction

et al. 2012

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“…13 In cranio-vertebral junction tuberculosis, despite extensive erosion of the clivus, C1 and C2, and spinal cord compression, the patients can effectively be managed with antituberculosis therapy alone. 9,16 We could deduce that significant cord compression and spinal extension of abscess were significantly associated with outcome in cervical spine tuberculosis. These observations indicated that extensive tuberculous involvement of the spinal cord was responsible for the poor outcome.…”

Section: Discussionmentioning

confidence: 93%

“…8 Even in patients with cranio-vertebral junction tuberculosis, antituberculosis therapy is the mainstay of treatment along with neck stabilization regardless of the extent of bony destruction. 9 If atlantoaxial instability is present, surgery may be contemplated. [10][11][12] Regarding cervical spinal tuberculosis only limited data, either in the form of isolated cases or small case series, are available.…”

Section: Introductionmentioning

confidence: 99%

Outcome assessment in conservatively managed patients with cervical spine tuberculosis

et al. 2014

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Study design: Cervical spine tuberculosis is a relatively less frequent form of spinal tuberculosis. Cervical spine tuberculosis has a greater propensity to involve the spinal cord and results in major sensory motor deficit. In this prospective study, we aimed to evaluate the clinical and imaging predictors of outcome in conservatively managed patients. Methods: In this study, 42 patients of cervical spine tuberculosis were included. Patients were subjected to a detailed clinical evaluation and magnetic resonance imaging. Patients were treated with antituberculosis treatment and were followed up for 18 months. The Modified Barthel index (MBI) was used to assess the disability. Good outcome was defined as MBI 412 and poor outcome as MBI p12. Clinical and imaging characteristics were used to analyze the predictors of outcome, using univariate and multivariate analysis. Results: Four (9.5%) patients required surgery. Data from 38 patients, who were conservatively managed, were analyzed for predictors of outcome. Among conservatively managed patients, at presentation, 29 patients had an MBI score of p12. At 18 months, the majority of patients (81.6%) had a good outcome. On univariate analysis, a duration of illness 43 months, a major motor deficit, bladder involvement, flexor spasms, significant cord compression and spinal extension of the abscess were significantly associated with a poor outcome. However, on multivariate analysis significant cord compression (P ¼ 0.003) and spinal extension (P ¼ 0.02) showed a significant correlation with a poor outcome. Conclusion: Medical management was effective in cervical spine tuberculosis. Patients with significant cord compression and spinal extension of the abscess showed poorer outcome.

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“…It is known for its ability to present in various forms and guises at different sites [5]. Pyomyositis is the term used to describe a bacterial infection of skeletal muscle with formation of an abscess.…”

Section: Discussion and Treatmentmentioning

confidence: 99%

Orthopaedic Case of the Month: A 25-Year-Old Man with a Paramedian Painful Lump over the Anterior Chest Wall

Arora

Sural

Dhal

2011

Clinical Orthopaedics &Amp; Related Research

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A 25-year-old Indian man presented with a swelling of 3-weeks duration over the anterior aspect of his left chest (Fig. 1). The swelling was painful and associated with intermittent low-grade fever. It was insidious in onset and gradually progressive in size. There was no history of cough, hemoptysis, recent weight loss, anorexia, pruritus, seizures, or similar swellings elsewhere in the body. The swelling was not associated with any preceding history of trauma. His medical and family histories were noncontributory. The patient had visited a primary care physician who made the provisional diagnosis of muscular cysticercosis and referred the patient to our institution. On examination, the patient's vital signs were stable and there was no evidence of lymphadenopathy. His physical status was good. Local examination revealed a tender 5-cm 9 3-cm hemispheric fluctuant mass located over the left lower chest wall anteriorly near midline. Its margins were not well defined. Local temperature was increased. The overlying skin was freely mobile and there were no scars or sinuses. On attempted contraction of the upper abdominal muscles, there was no change in the size of the swelling; however, its side-to-side mobility became restricted, suggestive of a swelling arising in the muscle. The rest of the organ systems (respiratory system, abdomen, nervous system) appeared normal on clinical examination.Laboratory examination revealed an increased leukocyte count (13,400/mm 3 ) and the differential count was 60 polymorphonuclear leukocytes, 35 lymphocytes, two monocytes, and three eosinophils. The erythrocyte sedimentation rate (53 mm at the end of the first hour) and C-reactive protein (10.3 mg/L) levels were increased. The sputum examination was negative for acid-fast bacilli. Enzyme-linked immunosorbant assay (ELISA) was negative for cysticercosis antibodies. The ELISA test for HIV I and II antibodies was negative. The patient's immune status was normal with no other focus of infection.The patient underwent imaging studies and laboratory tests. Plain radiographs of the chest were normal. Ultrasound, CT, and MRI of the chest were performed.Based on the history, physical examination, and imaging studies, what is the differential diagnosis? Imaging InterpretationUltrasound examination revealed an oval hypoechoic lesion 5 cm 9 3 cm 9 2 cm in the substance of the left rectus abdominis muscle with increased echogenicity of adjacent muscle fibers suggestive of edema; however, there was no evidence of hyperechoic focus (suggestive of calcification or scolex) in the lesion. Doppler examination Each author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his institution approved the reporting of this case report, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participa...

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The Results of Nonoperative Treatment of Craniovertebral Junction Tuberculosis: A Review of Twenty-six Cases

Abstract: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Cited by 41 publications

References 18 publications

Tuberculosis of the craniovertebral junction

Tuberculosis of the craniovertebral junction

Outcome assessment in conservatively managed patients with cervical spine tuberculosis

Orthopaedic Case of the Month: A 25-Year-Old Man with a Paramedian Painful Lump over the Anterior Chest Wall

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