Tuberculosis of craniovertebral junction: Role of facets in pathogenesis and treatment

Goel, Atul

doi:10.4103/0974-8237.188418

Cited by 15 publications

(23 citation statements)

References 6 publications

(5 reference statements)

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“…The term 'upper cervical TB' encompasses cases which involve C1 and C2 vertebrae [atlantoaxial disease (AA)] and constitute 0.3 to 1% of all spinal TB. 2,3,15,20,22 Subaxial cervical TB (SACTB) is also a rare phenomenon and constitutes <3% of spinal TB. 1,14,16,18,19 Although mortality rates following CTB have reduced from 10% to 3% with effective antibiotic regimen, high rates of deformity and paraparesis (around 15-30%) have continued to remain issues of major concern.…”

Section: Epidemiologymentioning

confidence: 99%

Cervical spine TB – Current concepts in management

Shetty

Viswanathan

Rajasekaran

2021

J Orthop Surg (Hong Kong)

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Objective: Cervical tubercular disease (CTB) is a rare pathology and constitutes 3–5% of all spinal TB. It includes atlantoaxial TB and sub-axial TB. As the literature evidence on this subject is scarce, majority of issues concerning CTB are still controversial. The current narrative review comprehensively discusses the various aspects related to CTB. Literature search: An elaborate search was made using keywords cervical tuberculosis, atlantoaxial tuberculosis, sub-axial tuberculosis, and cervico-thoracic tuberculosis, on pubmed and google ( scholar.google.com ) databases on 2 December 2020. We identified crucial questions regarding CTB and included relevant articles pertaining to them. Results: The initial search using keywords cervical tuberculosis, atlantoaxial tuberculosis, sub-axial tuberculosis, and cervico-thoracic tuberculosis yielded 4128, 76, 3 and 9 articles on ‘pubmed’ database, respectively. A similar search using the aforementioned keywords yielded 1,96,000, 2130, 117 and 728 articles on ‘google scholar’ database. The initial screening resulted in the identification of 178 articles. Full manuscripts were obtained for these articles and thoroughly scrutinised at the second stage. Review articles, randomised controlled trials and level 1 studies were given preference. Overall, 41 articles were included. Conclusion: AATB and SACTB constitute 0.3 to 1% and 3% of spinal TB, respectively. The incidence of neuro-deficit in CTB is significantly more than other spinal TB. The general principles of management of CTB are similar to spinal TB elsewhere and medical therapy remains the cornerstone. Surgery is advocated in specific scenarios involving gross neuro-deficit, later stages of disease with significant bony/ligamentous disruptions, altered sagittal balance, drug resistance, and poor response to medications. The surgical approaches for AATB include anterior-alone, posterior-alone and combined approaches, although posterior access is the most preferred. Most of the studies on SACTB have supported the role of anterior approach. Additionally, posterior stabilisation may be necessary in specific scenarios. The overall long-term outcome in CTB is favourable.

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Section: Epidemiologymentioning

confidence: 99%

Cervical spine TB – Current concepts in management

Shetty

Viswanathan

Rajasekaran

2021

J Orthop Surg (Hong Kong)

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“…Unilateral suboccipital pain with ipsilateral 12 th nerve palsy is termed as OCS. [ 1 2 3 4 5 6 ] It was first described by Greenberg in 1981. [ 6 ] It is characterized by occipital pain radiating toward the mastoid, ear, and vertex.…”

Section: Discussionmentioning

confidence: 99%

“… 19 Dr. Goel highlighted the fact that CVJ tuberculosis may be managed conservatively in Stage II, provided there is no neurological deficit and patient is responding to drugs, in terms of pain. [ 1 ]…”

Section: Discussionmentioning

confidence: 99%

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Occipital condyle syndrome in a case of rotatory atlantoaxial subluxation (type II) with craniovertebral junction tuberculosis: Should we operate on “active tuberculosis?”

Kumar

Singh

Dikshit

et al. 2020

J Craniovert Jun Spine

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Tuberculosis of the craniovertebral junction is rare as well as intriguing. We present a unique amalgamation of three rare entities: craniovertebral tuberculosis, occipital condyle syndrome, and nontraumatic type II rotatory atlantoaxial dislocation in one patient. We reviewed the limited literature available and the underlying pathophysiology to highlight the pattern of the disease presentation, progression, and response to management options. A 13-year-old girl presented with neck pain, torticollis, and right hypoglossal weakness following a fall from stairs 10 months back. Radiological investigation suggested right occipital condylar destruction with right-sided neck tilt and rotatory atlantoaxial dislocation. The contrast magnetic resonance imaging was suggestive of craniovertebral tuberculosis with primary foci in the right lung (apical cavitary lesion). In view of an intact neurological condition, she was started on antitubercular treatment and she continues to do well during the follow-up. It remains debatable if an anticipation of this problem calls for a surgical addressal at the acute stage of the disease as a delayed correction is likely to be more complex. While a halo device is preferable in these cases, it remains cumbersome and less preferred in comparison to the Philadelphia collar.

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“…The resulting compression and destruction of the neuraxis as well as the vertebrobasilar tree leads to a constellation of symptoms and signs that often complicate the diagnosis of these disorders in children as well as in the adults. 18,51,53 .…”

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confidence: 99%