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Parent AS, Tu A. Conservative management for pediatric craniocervical Pott's disease: A case study and literature review. Childs Nerv Syst 2024; 40:1867-1871. [PMID: 38448674 DOI: 10.1007/s00381-024-06338-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
Craniocervical Pott's disease is rare, particularly in the pediatric population. The importance of motion preservation in this age group renders managing this disease even more challenging. The literature regarding craniocervical Pott's disease comes from endemic regions. Most authors will agree on early surgical intervention in cases of neurological compromise or severe instability, while patients with minimal symptoms will do well with conservative management. Controversy remains when patients are mildly symptomatic but with imaging findings concerning for significant instability. Here, we present the case of a 15-year-old male presenting with craniocervical tuberculoma with radiographic instability and advanced bony destruction without overt neurological deficits. He was managed with a rigid cervical collar and completed 1 year of anti-tuberculosis therapy. At 1-year follow-up, he had an intact range of motion, was pain-free, and remained neurologically intact. Although this case suggests good outcomes with conservative management are possible, more long-term follow-up is required to assess the need for delayed surgical intervention in this unique population.
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Affiliation(s)
| | - Albert Tu
- Children's Hospital of Eastern Ontario, Ottawa, Canada
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Duvuru S, Sanker V, Dave T, Agarwal P, Syed N. Stabilizing the unstable: Tuberculosis of the odontoid process with atlanto-occipital instability-Case report and review of literature. Clin Case Rep 2024; 12:e8379. [PMID: 38161635 PMCID: PMC10753637 DOI: 10.1002/ccr3.8379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/26/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024] Open
Abstract
Key Clinical Message Tuberculosis (TB) of the odontoid process is a rare but potentially, a debilitating condition. Surgical intervention, in the form of stabilizing the spine and decompressing the spinal cord, offers a tailored approach to managing this condition effectively and improving prognosis. Abstract Odontoid process tuberculosis (TB) is a rare condition that can cause spinal instability and neurological complications. Diagnosis of odontoid process TB is difficult and requires a combination of clinical, radiographic, and histopathological examinations. This report describes the treatment of a 46-year-old female with quadriparesis and intermittent fever. Radiological findings showed TB of the odontoid process with atlanto-axial dislocation causing compressive myelopathy. She underwent C1-C3 decompressive laminectomy and stabilization from C1 to C5. GeneXpert for TB was positive and she was started on anti-tuberculous medications. She regained power gradually and at 1 year follow-up she was ambulant without any support. The C1-C5 lateral mass screw and C1-C3 decompressive laminectomy approach, as highlighted in this case, offers an effective solution, enhancing patient quality of life, and preventing disease progression.
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Affiliation(s)
- Shyam Duvuru
- Consultant NeurosurgeonApollo Specialty HospitalsMaduraiTamil NaduIndia
| | - Vivek Sanker
- Team ErevnitesTrivandrumIndia
- Noorul Islam Institute of Medical SciencesTrivandrumIndia
| | - Tirth Dave
- Team ErevnitesTrivandrumIndia
- Bukovinian State Medical UniversityChernivtsiUkraine
| | - Pratik Agarwal
- Team ErevnitesTrivandrumIndia
- Lokmanya Tilak Municipal Medical CollegeMumbaiIndia
| | - Naureen Syed
- Team ErevnitesTrivandrumIndia
- UT MD Anderson Cancer CenterHoustonTexasUSA
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Chaudhary K, Pennington Z, Rathod AK, Laheri V, Bapat M, Sciubba DM, Suratwala SJ. Pathogenesis and Staging of Craniovertebral Tuberculosis: Radiographic Evaluation, Classification, and Natural History. Global Spine J 2023; 13:2155-2167. [PMID: 35164582 PMCID: PMC10538348 DOI: 10.1177/21925682221074671] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To radiographically evaluate Craniovertebral junction (CVJ) tuberculosis infection pathogenesis and to propose a modification to the Lifeso classification. METHODS A cohort of patients with radiologically or microbiologically identified CVJ tuberculosis treated at a single tertiary referral center in a TB endemic area was queried for characteristics about clinical presentation, treatment, and radiographic evidence of bone destruction and abscess formation were included. Disease was classified according to the Lifeso grading system and bony lesions were classified as either type 1 (preservation of underlying structure) or type 2 (damage of underlying structure). RESULTS 52 patients were identified (mean age 28.5 ± 13.4yr, 48% male; 14% with a prior history of tuberculosis). All presented with neck pain at presentation, 29% with rotatory pain, and 37% with myelopathy. Comparison by Lifeso type showed Lifeso III lesions had longer symptom durations (P = .03) and more commonly had periarticular or predental abscess formation (P < .05), spinal cord compression (P < .01), and more commonly involved the C2 body and atlanto-dental joint. Underlying bony destruction was more common for lesions of the lateral atlantoaxial joints and atlanto-dental joints in Lifeso III cases than in either Lifeso I or II (all P < .05). CONCLUSIONS The radiologic findings of the present series suggest CVJ TB infection may originate in the periarticular fascia with subsequent invasion into the adjacent atlanto-dental and lateral atlantoaxial joints in later disease. To reflect this proposed etiology, we present a modified Lifeso classification to describe the radiologic pathogenesis of CVJ TB.
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Affiliation(s)
- Kshitij Chaudhary
- Department of Orthopaedic Surgery, PD Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, Rochester, MN, USA
| | - Ashok K. Rathod
- Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Vinod Laheri
- Department of Orthopaedics, King Edward VII Memorial Hospital, Mumbai, India
| | - Mihir Bapat
- Department of Orthopaedics, King Edward VII Memorial Hospital, Mumbai, India
| | - Daniel M. Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA
| | - Sanjeev J Suratwala
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA
- Department of Orthopaedic Surgery, New York Orthopaedic and Spine Center, Northwell Health, Great Neck, NY USA
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Rathod TN, Marathe NA, Masilamani K, Jogani AD, Mohanty SS, Mallepally AR, Sathe AH. Are we neglecting long-term effects of vertebral shortening on pulmonary function in spinal tuberculosis? Spine Deform 2022; 10:169-176. [PMID: 34398396 DOI: 10.1007/s43390-021-00400-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE In developing part of the world, it is common to see complete destruction of vertebral bodies in tuberculosis. Our study aims to assess the effect of spinal tuberculosis with vertebral shortening on pulmonary function. METHODS Fifty cases of spinal TB (14 males, 36 females) managed both operatively and non-operatively, who presented to tertiary care institute between years 2011 and 2016 were assessed. Vertebral height loss was assessed by spinal deformity index (SDI). All patients underwent pulmonary function testing using same equipment sitting in upright position. RESULTS Mean age was 27.9 years (27.9 ± 11.9). 11 patients with mean SDI of 2.7 ± 1.1 showed normal lung function. 36 patients showed restrictive pattern of which 12 were mild, 14 were moderate and 10 showed severe pattern with a mean SDI of 3.8 ± 1.2, 5.6 ± 1.3 and 6.1 ± 1.4, respectively. 3 cases showed obstructive pattern. As the apex of curve shifted proximally, FVC% reduced. Increase in SDI value was associated with a fall in the vital capacity and FEV1. Increase in the kyphotic angle was associated with a deleterious effect on PFT results. CONCLUSIONS Risk stratification of pulmonary dysfunction resulting from vertebral body height loss due to kyphosis will emphasize the need for early detection of spinal tuberculosis before deformity occurs.
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Affiliation(s)
- Tushar N Rathod
- Department of Orthopedics, Seth G S Medical College and K.E.M. Hospital, Mumbai, 400012, India
| | - Nandan A Marathe
- Department of Orthopedics, Seth G S Medical College and K.E.M. Hospital, Mumbai, 400012, India.
| | - Kalaivanan Masilamani
- Department of Orthopedics, Seth G S Medical College and K.E.M. Hospital, Mumbai, 400012, India
| | - Abhinav D Jogani
- Department of Orthopedics, Seth G S Medical College and K.E.M. Hospital, Mumbai, 400012, India
| | - Shubhranshu S Mohanty
- Department of Orthopedics, Seth G S Medical College and K.E.M. Hospital, Mumbai, 400012, India
| | | | - Ashwin H Sathe
- Department of Orthopedics, Seth G S Medical College and K.E.M. Hospital, Mumbai, 400012, India
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Shetty AP, Viswanathan VK, Rajasekaran S. Cervical spine TB - Current concepts in management. J Orthop Surg (Hong Kong) 2021; 29:23094990211006936. [PMID: 34711081 DOI: 10.1177/23094990211006936] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
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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Affiliation(s)
- Ajoy Prasad Shetty
- Department of Spine surgery, 76290Ganga Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
| | | | - S Rajasekaran
- Department of Spine surgery, 76290Ganga Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
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Upadhyaya GK, Kumar A, Iyengar KP, Agarwal A, Jain VK. Current concepts in the diagnosis and management of tuberculosis of the elbow joint. J Clin Orthop Trauma 2021; 19:200-208. [PMID: 34150492 PMCID: PMC8185235 DOI: 10.1016/j.jcot.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/05/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022] Open
Abstract
Elbow is an uncommon joint to be affected by Mycobacterium tuberculosis infection. It is involved in approximately 1-5% of all cases with musculoskeletal tuberculosis (TB). Early diagnosis of TB of the elbow joint can be easily missed due to an indolent natural history, delay in presentation, and varied clinical features. Delay in diagnosis can lead to irreversible osteoarticular destruction and loss of joint function. Careful clinical assessment, adequate imaging, microbiological, and/or histopathological confirmation of Mycobacterium tuberculosis infection is essential for early diagnosis of TB of the elbow joint. Judicious and early administration of anti-tubercular therapy can lead to preservation of the joint and a satisfactory functional outcome. Surgical intervention may be needed in later stages of the disease to achieve control of the infection, correction of deformity, instability, and restoration of function.
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Affiliation(s)
- Gaurav Kumar Upadhyaya
- Department of Orthopaedics, All India Institute of Medical Sciences, Raebareli, UP, India
| | - Amit Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, Raebareli, UP, India,All India Institute of Medical Sciences, Raebareli, UP, India
| | | | - Anil Agarwal
- Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India,Corresponding author. Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Science, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India.
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Zhang Y, Wu Y, Fu S, Xia H, Ma X, Zhang K, Ai F. [Treatment of tuberculosis in craniovertebral junction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1507-1514. [PMID: 33319527 DOI: 10.7507/1002-1892.202005087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the method of treating tuberculosis in the craniovertebral junction and its effectiveness. Methods The clinical data of 18 patients with tuberculosis in the craniovertebral junction between July 2010 and January 2019 was analyzed retrospectively. There were 14 males and 4 females, aged 21 months to 75 years (median, 35 years). The disease duration ranged from 2 weeks to 60 months (median, 4 months), and the affected segment was C 0-C 3. Preoperative visual analogue scale (VAS) score was 6.7±1.5 and the Japanese Orthopaedic Association (JOA) score was 16.1±1.8. The American Spinal Cord Injury Association (ASIA) grading system was applied to classify their neurological functions, according to which there were 6 cases of grade D and 12 cases of grade E. Among 18 patients, 4 patients underwent conservative treatment, 1 patient removed tuberculosis via transoral approach, 1 patient removed tuberculosis via posterior cervical approach, and 12 patients removed tuberculosis via transoral approach immediately after posterior cervical (atlantoaxial or occipitalcervical) fusion and internal fixation. The VAS score, ASIA grading, and JOA score were applied to evaluate effectiveness. X-ray film, CT, and MRI were taken after treatment to evaluate the tubercular recurrence, cervical stability, and bone healing. Results All the patients were followed up 3 to 42 months (median, 12 months). At 3 months after treatment, the VAS score was 1.7±1.0, showing significant difference when compared with preoperative score ( t=15.000, P=0.000); and the JOA score was 16.7±1.0, showing no significant difference when compared with preoperative score ( t=1.317, P=0.205). According to ASIA grading, 6 patients with grade D before treatment had upgraded to grade E after treatment, while the remaining patients with grade E had no change in grading. The imaging examinations showed the good stability of the cervical spine. All patients had complete tuberculosis resection and no recurrence, and the patients who underwent internal fixation via posterior cervical approach achieved atlantoaxial or occipitalcervical bone fusion. Conclusion On the premise of regular chemotherapy, if there is no huge abscess causing dysphagia or dyspnea, atlantoaxial instability, and neurological symptoms, patients can undergo conservative treatment. If not, however, the transoral approach can be used to completely remove the tuberculosis lesion in the craniovertebral junction. One-stage debridement via transoral approach combined with posterior cervical fusion and internal fixation can achieve satisfactory effectiveness.
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Affiliation(s)
- Yu Zhang
- Department of Orthopedics, General Hospital of Southern Theater Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - You Wu
- Department of Orthopedics, General Hospital of Southern Theater Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - Suochao Fu
- Department of Orthopedics, General Hospital of Southern Theater Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - Hong Xia
- Department of Orthopedics, General Hospital of Southern Theater Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - Xiangyang Ma
- Department of Orthopedics, General Hospital of Southern Theater Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - Kai Zhang
- Department of Orthopedics, General Hospital of Southern Theater Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - Fuzhi Ai
- Department of Orthopedics, General Hospital of Southern Theater Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
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8
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Management of CVJ tuberculosis: the changing paradigm. Acta Neurochir (Wien) 2020; 162:2875-2886. [PMID: 32779024 DOI: 10.1007/s00701-020-04516-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The literature seems fractured for the management of craniovertebral junction (CVJ)-tuberculosis (TB). Presently, non-surgical management has been in vogue for neurologically intact patients. On the contrary, severely disabled cases of CVJ-TB continue to attract discussion, tilted towards surgical intervention. We present our experience with the non-surgical management of CVJ-TB tailored to their neurological status. METHODS Authors managed 37 cases (2004-2019; age 1-57 years, mean 36 years) of CVJ-TB, of which eighteen (18/37, 48.6%) were severely disabled (Nurick grade ≥ 3) with a mean follow-up of 84 months (48-192 months). Irrespective of the clinical status and radiological findings, all patients were managed on medical management only. Needle aspiration established pathology in 23 (62.2%) cases, while 9 (24.3%) cases required drainage of an abscess. All patients received 18 months of anti-tubercular therapy (ATT). In patients with Nurick grade ≥ 3 and documented AAD, we applied halo vest for 12 months to achieve cervical immobilization. Only hard cervical collar for 3 months was prescribed in patients with no documented AAD. RESULTS All minimally disabled cases (Nurick grade ≤ 2, n = 19) responded favorably (n = 18) to ATT, except for an infant, who succumbed to irreversible hypoxic brain damage due to the obstructed aero-digestive gateway. Of the severely disabled cases (Nurick grade ≥ 3, n = 18), 16 cases had favorable outcomes with only external orthosis (12) and 18-month ATT. One patient succumbed to multiple cerebral infarcts, while one required realignment surgery at CVJ due to fusion in malaligned position. CONCLUSION The authors conclude that the disability grading of CVJ-TB is pertinent only for assessing the functional disability of patients at presentation, with minimal relevance in deciding its management strategy. Irrespective of neurological disability, almost all patients respond favorably to external immobilization and ATT.
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Bao D, Li L, Gong M, Xiang Z. Treatment of Atlantoaxial Tuberculosis with Neurological Impairment: A Systematic Review. World Neurosurg 2019; 135:7-13. [PMID: 31550536 DOI: 10.1016/j.wneu.2019.09.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Tuberculosis (TB) in the atlantoaxial joint is a rare disease. However, the treatment of atlantoaxial TB with neurologic impairment is controversial. The aim of this review is to provide clinical outcomes of surgical and nonsurgical management of atlantoaxial TB. METHODS Databases including PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for English literature describing the treatment of atlantoaxial TB with neurologic deficits. The outcomes of conservative and surgical treatment approaches, including treatment failure, death, changes in neurologic impairment, and complications, were compared by performing odds ratio (OR) analysis. RESULTS Overall, 24 studies (247 patients) meeting the inclusion criteria were analyzed. Ninety-four patients (38%) were treated conservatively and 153 (62%) patients were treated surgically. The rate of poor outcomes was greater in the conservative group (14.89%) than in the surgery group (1.3%) (OR, 0.081; 95% confidence interval [CI], 0.016-0.39).There was no significant difference in mortality between the conservative (1.06%) and surgery (3.27%) groups (OR, 3.28; 95% CI, 0.494-27.381). There was no significant difference in muscle power improvement between the 2 treatments (conservative, 95.7%; surgery:, 94.8%; OR, 1.353; 95% CI, 0.291-4.925). CONCLUSIONS Conservative and surgical treatments both significantly improved neurologic deficits in most patients. Compared with conservative treatment, surgical treatment reduced treatment failures without significantly increasing the rates of neurologic deficit improvement or mortality.
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Affiliation(s)
- DingSu Bao
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Orthopaedics, Hospital Traditional Chinese Medicine Affiliated to Southwest Medical University, Luzhou, Sichuan, China
| | - Lang Li
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Orthopaedics, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, Sichuan, China
| | - Min Gong
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhou Xiang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Srivastava S, Marathe N, Bhosale S, Bhide P, Purohit S, Shende C, Raja B. Role of Additional Coronal Magnetic Resonance Imaging in Decompression and Reconstruction with or without Segment Salvage in Thoracic Spine Tuberculosis. Asian Spine J 2019; 13:992-1000. [PMID: 31352723 PMCID: PMC6894969 DOI: 10.31616/asj.2019.0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 03/18/2019] [Indexed: 11/23/2022] Open
Abstract
Study Design Retrospective and observational study. Purpose The present study aimed to develop guidelines for segment salvage or sacrifice based on the amount and status of the remnant portion of the vertebra as assessed by coronal magnetic resonance imaging (MRI) in addition to sagittal and axial images in thoracic spine tuberculosis (TB). Overview of Literature Indications for surgery have not changed significantly since the ‘middle path regimen’ was proposed by Tuli. Goals of modern surgical management of spinal TB include debridement of diseased vertebrae, spinal cord decompression, deformity correction, and spine stabilization. However, the extent of decompression has not been defined previously. Too less decompression will lead to compromised neurological recovery, whereas large extent of decompression is associated with increased surgical morbidity and longer segment to reconstruct. Methods Sixty-five patients with thoracic spine TB were divided into two groups (segment salvage/sacrifice) based on the thickness of the subchondral bone and endplate morphology of the vertebra as seen on MRI. The operative procedure in the form of instrumentation with Hartshill loop rectangle and sublaminar wire using the simultaneous anterior posterior approach in lateral position (versatile approach) was performed. The patients were analyzed for postoperative fusion, improvement in kyphosis angle, and followed up for development of complications. Results This method of deciding the level of fixation and segment salvage based on coronal MRI in addition to the sagittal and axial images provided good result in 64 of 65 patients, except for one patient in the segment sacrifice group who had graft buckling and resultant kyphosis. Conclusions For segment salvage, having a clear three-dimensional idea about the viable remnant bone is important. Viable salvaged segment reduces the morbidity of the procedure, length of the construct, and unnecessary debridement without compromising on the neural recovery and fusion rate. Hence, additional cone down coronal cuts must be required when MRI is suggestive for spinal TB because it will help in the decision making.
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Affiliation(s)
- Sudhir Srivastava
- Department of Orthopedics, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Nandan Marathe
- Department of Orthopedics, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Sunil Bhosale
- Department of Orthopedics, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Prajakta Bhide
- Department of Orthopedics, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Shaligram Purohit
- Department of Orthopedics, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Chetan Shende
- Department of Orthopedics, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Balgovind Raja
- Department of Orthopedics, Seth GS Medical College and KEM Hospital, Mumbai, India
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11
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Abnormalities of the craniovertebral junction in the paediatric population: a novel biomechanical approach. Clin Radiol 2018; 73:839-854. [DOI: 10.1016/j.crad.2018.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 05/15/2018] [Indexed: 12/20/2022]
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Megaloikonomos PD, Igoumenou V, Antoniadou T, Mavrogenis AF, Soultanis K. Tuberculous Spondylitis of the Craniovertebral Junction. J Bone Jt Infect 2016; 1:31-33. [PMID: 28529850 PMCID: PMC5423568 DOI: 10.7150/jbji.15884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Craniovertebral junction tuberculosis is rare, accounting for 0.3 to 1% of all tuberculous spondylitis cases. MR imaging is the modality of choice to detect bone involvement, abscess formation and subligamentous spreading of the pus, to differentiate from other lesions affecting the craniovertebral junction, and to determine the efficacy of treatment. Given the fact that surgical treatment of patients with craniovertebral junction tuberculosis has been associated with a high mortality rate ranging up to 10% and recurrence rate ranging up to 20%, conservative is the standard of treatment for most patients. This article presents a patient with craniovertebral junction Mycobacterium tuberculosis infection diagnosed with CT-guided biopsy. A halo vest was applied and antituberculous treatment with rifampicin, isoniazid and ethambutol was initiated. At 6-month follow-up, the patient was asymptomatic; CT of the cervical spine showed healing of the bony lesions. The halo vest was removed and physical therapy was recommended. Antituberculous treatment was continued for a total of 18 months, without any evidence of infection recurrence.
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Affiliation(s)
| | | | | | | | - Konstantinos Soultanis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
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Appaduray SP, Lo P. Nonoperative management of craniovertebral junction and cutaneous tuberculosis. Surg Neurol Int 2015; 6:157. [PMID: 26539308 PMCID: PMC4604638 DOI: 10.4103/2152-7806.166801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 09/03/2015] [Indexed: 11/25/2022] Open
Abstract
Background: Craniovertebral junction (CVJ) and cutaneous tuberculosis (TB) are both rare, each occurring in 0.3–1.0% of patients. To our knowledge, there are no existing cases reporting these manifestations of TB simultaneously. We report a case of TB involving the left CVJ as well as the skin, and discuss our management while providing a review of the literature. Case Description: An adult patient was presented with progressive nocturnal neck pain associated with the development of several skin lesions. Investigations revealed multiple osseous lesions including the left CVJ. Biopsy of the CVJ lesion was unamenable due to proximity of the vertebral artery; therefore, the patient underwent biopsy of the other sites. Histological examination demonstrated features consistent with TB infection and the patient commenced 12 months of standard anti-TB therapy with cervical spine immobilization. At 2-month review, the patient was well with a near-complete resolution of neck pain and cutaneous lesions. Repeat imaging at 6 months follow-up demonstrated a stable C1 lesion with no evidence of instability. Conclusion: CVJ TB may be treated solely with anti-TB therapy and immobilization to good effect if there is no gross instability or neurological deficit. Similarly, cutaneous TB responds well to standard anti- TB therapy. Our experience suggests that co-existing tuberculous lesions in the CVJ and skin can be simultaneously managed with standard therapy without significant alterations to treatment regimes or prognosis.
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Affiliation(s)
| | - Patrick Lo
- Department of Neurosurgery, The Royal Melbourne Hospital, VIC 3050, Australia
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Agarwal A, Kant KS, Kumar A, Shaharyar A. One-year multidrug treatment for tuberculosis of the cervical spine in children. J Orthop Surg (Hong Kong) 2015; 23:168-73. [PMID: 26321543 DOI: 10.1177/230949901502300210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To review the clinical and radiological features and treatment outcome in 22 children who underwent one-year antitubercular multidrug treatment for tuberculosis of the cervical spine. METHODS Records of 13 boys and 9 girls aged 2 to 12 (mean, 9.1) years who underwent one-year antitubercular multidrug treatment for tuberculosis of the cervical spine were reviewed. Tuberculosis involved the atlantoaxial region (C1-C2) in 7 patients, mid-cervical region (C3-C7) in 8, cervicodorsal region (C6-T3) in 3, contiguous multilevels in 2, and non-contiguous multifocal areas in 2. The mean number of vertebrae involved was 2.8 (range, 1-8). The mean symptom duration was 2.5 (range, 0.25-6) months. Three patients had neurological deficits. Antitubercular multidrug treatment included an intensive phase for 2 months and a continuation phase for 10 months, using isoniazid, rifampicin, pyrazinamide, and ethambutol. RESULTS At a mean of 2.25 (range, 0.5-5) years after treatment, no patient had recurrence, pain, or dynamic instability. Full range of movement was achieved after a mean of 2.7 (range, 1-4) months in all but 3 patients. In the 3 patients with neurological deficits, recovery was achieved after a mean of 8 (range, 5-14) weeks. Soft tissue swelling resolved after a mean of 11 (range, 8-12) weeks. Remineralisation of vertebrae occurred after a mean of 2 (range, 2-6) months. Spontaneous vertebral fusion occurred in only 6 of 22 patients after a mean of 36 (range, 18-72) months. Three patients developed kyphotic deformity. CONCLUSION Antitubercular multidrug treatment is a viable option for children with tuberculosis of the cervical spine, even in the presence of neurological deficits. Development of deformity is not common; interbody fusion is usually delayed. Patients with contiguous multilevel involvement with vertebral erosion or collapse should be closely monitored for development of late deformity.
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Affiliation(s)
- Anil Agarwal
- Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalya, Geeta Colony, Delhi, India
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Treatment of thoracic or lumbar spinal tuberculosis complicated by resultant listhesis at the involved segment. Clin Neurol Neurosurg 2014; 125:1-8. [DOI: 10.1016/j.clineuro.2014.06.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/16/2014] [Accepted: 06/29/2014] [Indexed: 11/20/2022]
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Outcome assessment in conservatively managed patients with cervical spine tuberculosis. Spinal Cord 2014; 52:489-93. [PMID: 24752293 DOI: 10.1038/sc.2014.49] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 03/18/2014] [Accepted: 03/22/2014] [Indexed: 11/08/2022]
Abstract
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 >12 and poor outcome as MBI ⩽12. 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 ⩽12. At 18 months, the majority of patients (81.6%) had a good outcome. On univariate analysis, a duration of illness >3 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=0.003) and spinal extension (P=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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Meena S, Barwar N, Gupta T, Chowdhury B. Spinal Tuberculosis Presenting as Abdominal Pain: Rare Presentation of a Common Disease. Oman Med J 2014; 29:e069. [PMID: 30838098 DOI: 10.5001/omj.2014.40] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 25-year-old male presented with complaints of abdominal pain for the past two months. He was prescribed Buscopan and omeprazole by a general surgeon. It was only when patient started complaining of backache that he was referred to an orthopedic surgeon. On examination of spine, there was tenderness at the upper dorsal spine. A diagnosis of Pott's disease affecting the upper dorsal spine was made. Magnetic resonance imaging (MRI) confirmed the vertebral changes and showed subligamentous spread of paravertebral masses from D2 to D7. This case illustrates the unusual form in which spine tuberculosis can present. High index of suspicion is necessary for early diagnosis and prompt management. General surgeons should be aware of this atypical presentation of Pott's disease.
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Affiliation(s)
- Sanjay Meena
- Department of Orthopaedics,All India Institute of Medical Sciences, Ansari Nagar,New Delhi1100029,India
| | - Nilesh Barwar
- Department of Orthopaedics,All India Institute of Medical Sciences, Ansari Nagar,New Delhi1100029,India
| | - Tusshar Gupta
- Department of Orthopaedics,All India Institute of Medical Sciences, Ansari Nagar,New Delhi1100029,India
| | - Buddhadev Chowdhury
- Department of Orthopaedics,All India Institute of Medical Sciences, Ansari Nagar,New Delhi1100029,India
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Zhang X, Ji J, Liu B. Management of spinal tuberculosis: a systematic review and meta-analysis. J Int Med Res 2013; 41:1395-407. [PMID: 24045167 DOI: 10.1177/0300060513498023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE A systematic review and meta-analysis of randomized controlled trials (RCTs) studying the clinical benefit of chemotherapy with surgical intervention over chemotherapy alone for the treatment of spinal tuberculosis. METHODS Relevant RCTs were identified by computerized database searches. Trial eligibility and methodological quality were assessed and data were extracted and analysed using odds ratios with 95% confidence intervals. The primary outcome measure was kyphosis angle. RESULTS The literature search identified two RCTs conducted in the 1970s and 1980s and a Cochrane Database Systematic Review published in 2006. There were no significant between-group differences in kyphosis angle, bony fusion, bone loss or development of neurological deficit. CONCLUSIONS There is no obvious statistically significant clinical precedence to suggest that routine surgery will improve the prognosis of patients with spinal tuberculosis.
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Affiliation(s)
- Xifeng Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China
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Rasouli MR, Mirkoohi M, Vaccaro AR, Yarandi KK, Rahimi-Movaghar V. Spinal tuberculosis: diagnosis and management. Asian Spine J 2012; 6:294-308. [PMID: 23275816 PMCID: PMC3530707 DOI: 10.4184/asj.2012.6.4.294] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 12/02/2011] [Accepted: 01/17/2012] [Indexed: 01/11/2023] Open
Abstract
The spinal column is involved in less than 1% of all cases of tuberculosis (TB). Spinal TB is a very dangerous type of skeletal TB as it can be associated with neurologic deficit due to compression of adjacent neural structures and significant spinal deformity. Therefore, early diagnosis and management of spinal TB has special importance in preventing these serious complications. In order to extract current trends in diagnosis and medical or surgical treatment of spinal TB we performed a narrative review with analysis of all the articles available for us which were published between 1990 and 2011. Althoug h the development of more accurate imaging modalities such as magnetic resonance imaging and advanced surgical techniques have made the early diagnosis and management of spinal TB much easier, these are still very challenging topics. In this review we aim to discuss the diagnosis and management of spinal TB based on studies with acceptable design, clearly explained results and justifiable conclusions.
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Affiliation(s)
- Mohammad R. Rasouli
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Orhtopaedics and Neurosurgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, USA
| | - Maryam Mirkoohi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alexander R. Vaccaro
- Department of Orhtopaedics and Neurosurgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, USA
| | - Kourosh Karimi Yarandi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Research Centre for Neural Repair, University of Tehran, Tehran, Iran
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Tuberculosis of the craniovertebral junction. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22 Suppl 4:612-7. [PMID: 23053749 DOI: 10.1007/s00586-012-2497-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 08/25/2012] [Accepted: 08/29/2012] [Indexed: 10/27/2022]
Abstract
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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Abstract
STUDY DESIGN A retrospective chart review. OBJECTIVE To describe the presentation and the rationale for management of pathological odontoid fracture and complete odontoid destruction in craniovertebral junction tuberculosis (CVJ TB). SUMMARY OF BACKGROUND DATA Presentation of CVJ TB ranges from minor osteomyelitic changes to severe structural damage leading to instability. Structural damage to the odontoid process is poorly characterized in the literature. Inadequate knowledge about the radiological presentations has led to controversy in the management of CVJ TB. METHODS The cohort consisted of 15 consecutive patients with CVJ TB, with structural damage to the odontoid process in the form of either odontoid fracture (n = 7) or complete odontoid destruction (n = 8). These patients presented with pain, neurological deficit, torticollis, dysphagia, or respiratory distress. The cause of neurological deficit was craniocervical instability characterized as anterioposterior (n = 15), rotatory (n = 4), and vertical (n = 6). Displacement reduced anatomically in 13 patients. Apart from antibiotics, all patients were treated surgically by either C1-C2 fusion (n = 7) or occipitocervical fusion (n = 8). RESULTS Average duration of follow-up was 3.6 years (range, 1.5-8 yr). All patients achieved normal neurological status. No complications were noted, except for 1 case, who had a loss of reduction after the use of Hartshill rectangle for occipitocervical fusion. Postoperative computed tomographic scan showed nonunion of odontoid fracture in 2 of 4 patients. No patient of odontoid destruction, of the 5 investigated, revealed structural reformation of the dens. CONCLUSION CVJ TB can severely damage the odontoid process, resulting in atlantoaxial dislocation. In these patients, surgery restores and maintains the craniocervical alignment and has a predictable outcome compared with conservative therapy. Pathological odontoid fractures have the potential to go into nonunion. Odontoid process once destroyed completely is rarely restored after antibiotic therapy.
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Abstract
Spinal tuberculosis is a destructive form of tuberculosis. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Spinal tuberculosis is more common in children and young adults. The incidence of spinal tuberculosis is increasing in developed nations. Genetic susceptibility to spinal tuberculosis has recently been demonstrated. Characteristically, there is destruction of the intervertebral disk space and the adjacent vertebral bodies, collapse of the spinal elements, and anterior wedging leading to kyphosis and gibbus formation. The thoracic region of vertebral column is most frequently affected. Formation of a 'cold' abscess around the lesion is another characteristic feature. The incidence of multi-level noncontiguous vertebral tuberculosis occurs more frequently than previously recognized. Common clinical manifestations include constitutional symptoms, back pain, spinal tenderness, paraplegia, and spinal deformities. For the diagnosis of spinal tuberculosis magnetic resonance imaging is more sensitive imaging technique than x-ray and more specific than computed tomography. Magnetic resonance imaging frequently demonstrates involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and presence of vertebral column deformities. Neuroimaging-guided needle biopsy from the affected site in the center of the vertebral body is the gold standard technique for early histopathological diagnosis. Antituberculous treatment remains the cornerstone of treatment. Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. With early diagnosis and early treatment, prognosis is generally good.
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Affiliation(s)
- Ravindra Kumar Garg
- Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India.
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Donald P. The chemotherapy of osteo-articular tuberculosis with recommendations for treatment of children. J Infect 2011; 62:411-39. [DOI: 10.1016/j.jinf.2011.04.239] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 04/29/2011] [Indexed: 02/07/2023]
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Hoshino C, Narita M. Craniovertebral junction tuberculosis: a case report and review of the literature. J Infect Chemother 2010; 16:288-91. [PMID: 20232104 DOI: 10.1007/s10156-010-0052-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 02/17/2010] [Indexed: 10/19/2022]
Abstract
Craniovertebral junction tuberculosis (CVJ TB) is a rare disease, potentially causing significant neurological deficits and even death. We report on a 80-year-old woman presenting with CVJ TB without pulmonary involvement. The diagnosis was made by biopsy of the cervical lymph node showing granulomatous caseation necrosis. Despite extensive erosion of the clivus, C1, and C2, and spinal cord compression, the patient was effectively managed with antituberculous drug therapy and conservative neck stabilization. Neck pain resulting from cervical spondylosis is common in elderly people. However, even if there is no obvious pulmonary involvement, CVJ TB should be considered in the differential diagnosis, especially in patients with painful neck stiffness. The most useful method available for evaluating this region is a combination of CT scan and MRI study. CVJ TB can be managed conservatively, except for a selected few cases, regardless of the extent of bony destruction.
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Affiliation(s)
- Chisho Hoshino
- General Internal Medicine, Ohta-Nishinouchi Hospital, Koriyama, Fukushima 963-8558, Japan.
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Ould-Slimane M, Lenoir T, Dauzac C, Breitel D, Hoffmann E, Guigui P, Ilharreborde B. Odontoid process pathologic fracture in spinal tuberculosis. ORTHOPAEDICS & TRAUMATOLOGY, SURGERY & RESEARCH : OTSR 2010; 96:80-4. [PMID: 20170863 DOI: 10.1016/j.rcot.2009.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Accepted: 10/06/2009] [Indexed: 02/02/2023]
Abstract
Craniovertebral junction tuberculosis is a rare lesion in which treatment remains controversial. Options range from conservative treatment to surgery, independently of any associated neurological threat. We here report the first case of pathologic odontoid fracture in a context of spinal tuberculosis, complicated by unusual neurological evolution. The patient presented with non-contiguous multifocal tuberculosis, of which there have previously been only 6 reported cases.
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Affiliation(s)
- M Ould-Slimane
- Service de chirurgie orthopédique, hôpital Beaujon, Assistance publique-Hôpitaux de Paris, université Paris-VII, 100, boulevard du Général-Leclerc, 92110 Clichy, France
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