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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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Chaudhary K, Pennington Z, Rathod AK, Laheri V, Bapat M, Sciubba DM, Suratwala SJ. Application of the Modified Lifeso Radiographic Staging System to the Management and Outcomes for Craniocervical Tuberculosis. Clin Neurol Neurosurg 2022; 222:107453. [DOI: 10.1016/j.clineuro.2022.107453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/18/2022] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
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Liu Z, Xu Z, Zhang Y, Wang X, Zhang Z, Jiang D, Jia R. Endoscopy-assisted anterior cervical debridement combined with posterior fixation and fusion for the treatment of upper cervical spine tuberculosis: a retrospective feasibility study. BMC Musculoskelet Disord 2022; 23:126. [PMID: 35135516 PMCID: PMC8827151 DOI: 10.1186/s12891-022-05084-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/03/2022] [Indexed: 02/06/2023] Open
Abstract
Background This retrospective study aimed to determine the feasibility and efficacy of endoscopy-assisted anterior cervical debridement combined with posterior fixation and fusion in patients with upper cervical spine tuberculosis. Methods Between June 2008 and January 2016, 17 patients (10 men and 7 women) with upper cervical spine tuberculosis underwent endoscopy-assisted anterior cervical debridement combined with posterior fixation and fusion. Anti-tuberculosis treatment was administered for 2–4 weeks preoperatively and 12–18 months postoperatively. The clinical and radiographic data of the patients were analyzed. Results The operation was successfully completed in all patients. Neck pain and stiffness were relieved after the surgery in all patients. The mean operation time was 210.0 ± 21.2 min, and the mean intraoperative blood loss was 364.7 ± 49.6 mL. The mean follow-up duration was 68.1 ± 6.7 months. The erythrocyte sedimentation rate returned to normal by 3 months postoperatively. Visual analog scale scores for neck pain were significantly lower postoperatively than preoperatively. All patients had significant postoperative neurological improvement. Patient-reported outcomes, as measured using the Kirkaldy-Willis criteria, were as follows: excellent, 12 patients; good, 4 patients; fair, 1 patient; and poor, 0 patients. Bone fusion was achieved at 10.9 ± 1.9 months after the surgery; no cases of instrument loosening or fracture occurred. Conclusion Endoscopy-assisted anterior cervical debridement combined with posterior fixation and fusion is a feasible and effective surgical method for the treatment of upper cervical spine tuberculosis. It can be used to restore upper cervical spine stability and facilitate spinal healing.
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Affiliation(s)
- Zheng Liu
- Hunan Children's Hospital, 86# Ziyuan Road, Changsha, 410007, Hunan, China
| | - Zhenchao Xu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, 410008, Hunan, China. .,Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, 410008, Hunan, China.
| | - Yilu Zhang
- Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, 410008, Hunan, China
| | - Xiyang Wang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, 410008, Hunan, China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, 410008, Hunan, China
| | - Zhen Zhang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, 410008, Hunan, China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, 410008, Hunan, China
| | - Dingyu Jiang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, 410008, Hunan, China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, 410008, Hunan, China
| | - Runze Jia
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, 410008, Hunan, China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, 410008, Hunan, China
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Ahuja K, Ifthekar S, Mittal S, Yadav G, Sarkar B, Kandwal P. Defining mechanical instability in tuberculosis of the spine: a systematic review. EFORT Open Rev 2021; 6:202-210. [PMID: 33841919 PMCID: PMC8025706 DOI: 10.1302/2058-5241.6.200113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Over the years, a number of authors have used different working definitions of instability in tuberculosis of the spine (TB spine). However, no clear consensus exists to define instability in TB spine. The current systematic review addresses the question 'What defines instability in TB spine'?A comprehensive medical literature search was carried out to identify all the studies which defined instability in the setting of spinal TB. The extracted data included the clinical, X-ray and CT or MRI-based definitions.The current review identified lesser age, junctional region of the spine, mechanical pain and 'instability catch', kyphotic deformity above 40 degrees, pan-vertebral or bilateral facetal involvement and multifocal contiguous disease involving more than three vertebrae as predictors for spinal instability in the dorso-lumbar spine.Cervical kyphosis more than 30 degrees and facetal or pan-vertebral involvement were found to be the factors used to define instability in subaxial cervical spine.With respect to C1-C2 TB spine, migration of the tip of the odontoid above the McRae or McGregor line or anterior translation of C1 over C2 were considered as determinants for instability.Although definitive conclusions could not be drawn due to lack of adequate evidence, the authors identified factors which may contribute towards instability in TB spine. Cite this article: EFORT Open Rev 2021;6:202-210. DOI: 10.1302/2058-5241.6.200113.
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Affiliation(s)
- Kaustubh Ahuja
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Uttarakhand, India
| | - Syed Ifthekar
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Uttarakhand, India
| | - Samarth Mittal
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Uttarakhand, India
| | - Gagandeep Yadav
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Uttarakhand, India
| | - Bhaskar Sarkar
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Uttarakhand, India
| | - Pankaj Kandwal
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Uttarakhand, India
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Rahimizadeh A, Williamson W, Rahimizadeh S, Amirzadeh M. Painful torticollis due to tubercular atlantoaxial rotatory fixation: A case report. Surg Neurol Int 2021; 11:440. [PMID: 33408925 PMCID: PMC7771482 DOI: 10.25259/sni_663_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/25/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Tubercular atlantoaxial, rotary dislocation warranting fixation (AARF) is an extremely rare event. Case Description: AARF was suspected in a 23-year-old female with painful torticollis. When diagnostic studies documented unilateral destruction of the left lateral mass of the atlas, she underwent removal of the lateral mass, reduction of the deformity, and C1-C2 fusion/reconstruction utilizing an iliac bone graft. Laboratory tests and the pathologic surveys were all consistent with the diagnosis of underlying tuberculosis. Conclusion: We present a case of tubercular atlantoaxial, rotary dislocation (AARF) in a patient who warranted C1-C2 decompression, reduction, and fusion.
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Affiliation(s)
- Abolfazl Rahimizadeh
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Walter Williamson
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Rahimizadeh
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahan Amirzadeh
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
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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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Salaffi F, Carotti M, Di Carlo M, Sessa F, Malavolta N, Polonara G, Giovagnoni A. Craniocervical junction involvement in musculoskeletal diseases: an area of close collaboration between rheumatologists and radiologists. Radiol Med 2020; 125:654-667. [DOI: 10.1007/s11547-020-01156-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/10/2020] [Indexed: 02/07/2023]
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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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Wang B, Shang R, Yang T, Zhang H, Hu H, Hu W, Hao D. Evaluation of clinical outcomes of one-stage anterior and posterior surgical treatment for atlantoaxial tuberculosis complicated with neurological damage. BMC Musculoskelet Disord 2019; 20:148. [PMID: 30954072 PMCID: PMC6451780 DOI: 10.1186/s12891-019-2539-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 03/27/2019] [Indexed: 11/29/2022] Open
Abstract
Background Surgical treatment is mainly used for atlantoaxial tuberculosis with neurological damage. However, the anatomic structure around the atlantoaxial joint is complex, and the position of vertebral body is deep, which increases the difficulty of the operation and it is challenging for the surgeon to develop surgical strategy. The purpose of this study was to evaluate the clinical outcomes of one-stage combined anterior and posterior surgical treatment approach for atlantoaxial tuberculosis with neurological impairment. Methods From January 2005 to January 2015, 12 patients suffering from atlantoaxial tuberculosis with neurological impairment were surgically treated by one-stage combined anterior and posterior approach. Preoperative CT scanning and MRI imaging showed unilateral or bilateral lateral mass destruction of the atlas, and varying destruction degrees of odontoid process, loss of atlantoaxial stability, and tuberculosis focus into the spinal canal resulting in the corresponding spinal cord compression in all patients. The preoperative neurological classifications were Class C for 4 cases, D for 8 cases according to the American Spinal Injury Association (ASIA) system. Quadruple sensitive anti-TB drug treatment was used in all 12 patients preoperative and postoperative. Patients’ clinical symptoms and neurological function recovery were evaluated by comparing the Visual Analogue Scale (VAS) score, Neck Disability Index (NDI), Japanese Orthopedic Association (JOA) score and ASIA grading before operation and at the final follow-up. Results Mean surgical duration was 263.3 ± 43.6 min. Intraoperative blood loss was averagely 529.2 ± 169.8 ml. The average fusion period was 7.3 ± 1.5 months. No instrumentation loosening, migration or breakage was observed during the follow-up of 6.5 ± 2.9 years. The VAS, NDI and JOA scores were significantly changed to 1.00 ± 0.95, 9.50 ± 3.34 and 15.42 ± 1.44 at last follow-up (P < 0.05). The neurological function of all 12 patients was recovered to Class E according to the ASIA grading system. Conclusion In the treatment of atlantoaxial tuberculosis with neurological impairment, one-stage combined anterior and posterior surgical approach have the ability to complete debridement and decompression, and reconstruction of the stability of the upper cervical spine.
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Affiliation(s)
- Biao Wang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China
| | - Rongan Shang
- Department of Orthopaedics, Baoji Hospital of traditional Chinese Medicine, No. 43 Baofu Road, Baoji, 721000, Shaanxi, China
| | - Tong Yang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China
| | - Haiping Zhang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China
| | - Huimin Hu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China
| | - Wei Hu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China.
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Abstract
Reporting a rare scenario of hypoglossal nerve palsy in craniovertebral tuberculosis. Two patients presented in outpatient department with chief complaints of pain in neck, restricted neck movements, gait changes, difficulty in speech and weakness in all the extremities. On the basis of clinicoradiological correlation, the patients were diagnosedwithtuberculosis of C1-C2 spine. They were started on antituberculosis therapy Category 1. The patients improved clinically and there was no worsening of symptoms, but they noticed tongue deviation and hypotrophy on one side of the tongue. C1-C2 tuberculosis along with cranial nerve palsy, especially hypoglossal nerve is one of the rarest presentations. Hypoglossal nerve arises from the medulla, exits through hypoglossal canal in the base of the skull and traverses neck to supply tongue musculature. Prevertebral fascia extends from superior mediastinum to base of the skull. Abscess in this area can cause either actual compression of the hypoglossal canal or C1 and base of the skull dissociation which can lead to compression of the canal.
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Affiliation(s)
- Rohit Pandey
- Department of Orthopedics, UCMS and GTB Hospital, New Delhi, India
| | - Himanshu Bhayana
- Department of Orthopedics, UCMS and GTB Hospital, New Delhi, India
| | - Ish Kumar Dhammi
- Department of Orthopedics, UCMS and GTB Hospital, New Delhi, India
| | - Anil Kumar Jain
- Department of Orthopedics, UCMS and GTB Hospital, New Delhi, India
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Anterior Cervical Retropharyngeal Debridement Combined With Occipital Cervical Fusion to Upper Cervical Tuberculosis. Spine (Phila Pa 1976) 2016; 41:104-10. [PMID: 26679892 DOI: 10.1097/brs.0000000000001169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective analysis of 11 cases. OBJECTIVE The aim of the study was to evaluate the effectiveness of anterior cervical and retropharyngeal debridement combined with posterior occipital-cervical fusion in treatment of upper cervical spinal tuberculosis. SUMMARY OF BACKGROUND DATA The anterior approach simply could not provide strong fixation whereas the posterior treatment could not clear up the lesions completely. The method combining anterior and posterior approaches to treat the upper cervical tuberculosis is advisable. METHODS The clinical data of 11 patients with upper cervical tuberculosis who underwent an upper cervical operation in our hospital were retrospectively analyzed. All 11 patients underwent the surgery of anterior cervical and retropharyngeal approaches to debridement, and then, according to the different degrees of patient pedicle destruction and deformity, different occipitocervical approaches were used (either through pedicle screw or laminar screw fixation). After surgery, antituberculosis drugs were administered for 18 months. During the follow-up, neurological function, clinical symptoms, fusion, reducible degree, and complications were all evaluated and documented. RESULTS Surgeries for 11 patients were performed successfully; anatomical reduction was achieved in nine cases, bony fusion was achieved in all 11 patients, and all cases with tuberculosis were clinically cured in the 18 months after the operation. The Japanese Orthopaedic Association score increased from 8.4 ± 1.3 preoperative to 15.0 ± 1.3 in the last follow-up (P < 0.05). The occipitocervical visual analog scale decreased from 6.7 ± 0.6 preoperative to 0.6 ± 0.6 at the last follow-up (P < 0.05). No serious complications were documented during follow-up. CONCLUSION The approach of anterior cervical and retropharyngeal debridement combined with posterior occipitocervical fusion has been proved to be an effective treatment of upper cervical tuberculosis, which plays an important role in removing the lesions, restoring stability, and anatomical reduction. LEVEL OF EVIDENCE 4.
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