Cervical spine TB – Current concepts in management

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.

Efficacy of anterior debridement and bone grafting with fusion using internal fixation combined with anti-tuberculosis chemotherapy in the treatment of subaxial cervical tuberculosis

“…Cervical tuberculosis lesions were usually located in the anterior and middle column of the vertebra. Although there were several surgical approaches (anterior, anterior combined with posterior, and endoscopy-assisted anterior), the anterior approach was still a practical method for surgery, since the simple structure of incision, convenient procedure of internal xation, su cient exposure of lesion, and less recurrence of infection [1,2]. In this cohort, all patients with cervical tuberculosis had lesions concentrated in the lower cervical spine (C3 ~ C7), 23 patients with lesions involving more than two vertebral bodies, and 12 patients with typical symptoms of spinal cord compression.…”

“…The use of internal xation in the management of infectious diseases is still controversy [1,2,14]. Although previous theories had suggested that bio lms form on the surface of internal xation, which may be not conducive to the control of infection [23].…”

“…Spinal tuberculosis (TB) is the most common type of osteoarticular TB, accounting for 50% of all skeletal TB [1]. The incidence of cervical TB is rare, approximately 4.2-12% of spinal TB [2,3]. However, the anatomical structure of the cervical vertebra is adjacent to the multi-level spinal nerve roots and central nerve structure, where lesions may easily result in the symptoms of spinal cord compression.…”

Life-threatening disseminated tuberculosis masquerading as cervical spondylosis---Case report “Cervical TB v/s Cervical Spondylosis”

“…The incidence of neuro-deficits is also more. [ 3 ] Physicians often attribute neck pain to cervical spondylosis. We present a case of CTB, which was initially labeled as cervical spondylosis and conservatively managed.…”

Tuberculous Abscesses in the Head and Neck Region

“…In the case of abscess formation, different surgical options have been analyzed over many decades and have been found to be efficacious in combination with drug treatment [3]. Tuberculous spondylitis, or Pott disease, can lead to degeneration and even caseous necrosis of intervertebral discs, as can be seen between C3/4 and C6/7 above, or lytic destruction of vertebrae, as highlighted in C5 [4]. Globalization can result in the emergence and reemergence of infectious diseases such as TB in low-incidence countries [5].…”