Atlantoaxial tuberculosis: Outcome analysis

Sridharan, Srihari; Arumugam, Thiruvalluvan

doi:10.4103/ijmy.ijmy_55_17

Cited by 4 publications

(3 citation statements)

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“…The literature broadly classifies CTB into cranio-vertebral (CVJ) and sub-axial cervical disease (SACTB). 1,2,14,17,20,21 Additionally, lesions involving cervico-thoracic (CT) junctional levels need special consideration, owing to the biomechanical peculiarities of this transitional zone. 16 The pathophysiology, clinical presentation, diagnostic modalities and general principles of treatment of CTB are in similar lines with spinal TB elsewhere and have been discussed vide-infra.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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: Discussionmentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Cervical spine TB – Current concepts in management

Shetty

Viswanathan

Rajasekaran

2021

J Orthop Surg (Hong Kong)

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“…При этом шейные спондилиты рано осложняются вторичной миело-патией с высоким уровнем неврологических расстройств при определенной сложности проведения инвазивных диагностических манипуляций, в том числе закрытой трепанбиопсии, и ранних реконструктивных вмешательств [19][20][21]. Основная часть публикаций фокусируется на хирургических особенностях лечения данной патологии, в том числе оперативных доступах, вариантах пластического замещения резекционного дефекта передней колонны и режимах антибактериальной химиотерапии [22][23][24], лишь в последние годы смещаясь в сторону оценки качества жизни пациентов, возможности минимизации хирургической агрессии и анализа долгосрочных результатов операций с позиции параметров локального и глобального сагиттального баланса [24][25][26][27].…”

Section: Discussionunclassified

Chronic infectious lesions of the cervical spine in adults: monocentric cohort analysis and literature review

et al. 2021

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Objective. To analyze the results of surgical treatment of chronic infectious cervical spondylitis and literature data.Material and Methods. Design: retrospective monocentric cohort study for 2017–2020. The study included medical history and clinical and instrumental data of 25 patients who underwent 28 reconstructive surgeries on the suboccipital (n1 = 3) and subaxial (n2 = 25) spine. The average follow-up period was 1 year 2 months ± 4 months. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS), version 22.0.Results. The effect of the duration of the therapeutic pause (p = 0.043) and the T1 slope (T1S) (p = 0.022) on the intensity of vertebrogenic pain syndrome was established. When assessing the parameters of the sagittal balance a direct relationship between the age of patients and the value of cervical sagittal vertical axis (CSVA) (p = 0.035) was revealed, while CSVA (p = 0.514) and neck tilt angle (NTA) (p = 0.617) did not significantly affect the intensity of vertebral pain syndrome. The extent of vertebral destruction did not affect either the intensity of vertebral pain (p = 0.872) or the indices of the sagittal balance: CSVA (p = 0.116), T1S (p = 0.154), and NTA (p = 0.562). A significant predictor of postoperative complications is the level of comorbidity with an index of 7 or more (p = 0.027) according to the Charlson scale.Conclusion. The leading predictors of complications of surgical treatment of cervical infectious spondylitis are the Charlson comorbidity index (7 points or more) and the variant of anterior reconstruction (the use of a blocked extraspinal plate). The factors influencing the intensity of vertebrogenic pain syndrome in this pathology are the duration of the therapeutic pause and the magnitude of T1S compensation. Anterior reconstruction of the cervical spine in the presence of infectious spondylitis provides a correction of the sagittal balance parameters, with the possibility of long-term maintaining the achieved values.

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Treatment of Atlantoaxial Tuberculosis with Neurological Impairment: A Systematic Review

Bao

Gong

et al. 2020

World Neurosurgery

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Atlantoaxial tuberculosis: Outcome analysis

Cited by 4 publications

References 0 publications

Cervical spine TB – Current concepts in management

Cervical spine TB – Current concepts in management

Chronic infectious lesions of the cervical spine in adults: monocentric cohort analysis and literature review

Treatment of Atlantoaxial Tuberculosis with Neurological Impairment: A Systematic Review

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