Tuberculosis of spine (C1 to D4)

Abstract

Clinical data: Thirty-one patients with 33 lesions of spinal tuberculosis (C1 ± D4) are reported. The distribution of lesions was C1 ± C2 (11), C3 ± C6 (13), C7 ± D4 (9). Neurological complications were present in 6 (55%), 8 (61%) and 7 (78%) in each region respectively. Diagnosis: Increase in the prevertebral soft tissue shadow in a standard radiograph was a useful guide to resort to CT Scan/MRI to diagnose tuberculosis of C1 and C2 region at an early (pre-subluxation) stage. The diagnosis of TB spine from C3 ± C6 was made con®dently on clinico-radiological features. The anterior convexity and forward displacement of tracheal shadow of more than 8 mm from the vertebral bodies in a lateral view of plain X-ray and widening of superior mediastinum in an AP X-ray are useful indicators of tuberculous involvement at cervicodorsal region (C7 ± D4). CT Scan/MRI should be done for early diagnosis in those cases with a high index of suspicion. Treatment and outcome: 12/33 lesions without neural complications healed with antitubercular drugs and the use of suitable orthosis. Out of 21 lesions with neural complications 14 recovered by local rest, skull traction and multidrug therapy. Seven lesions were surgically decompressed. Of these, ®ve recovered completely, two did not achieve useful recovery. The neural recovery following the middle path regimen for tuberculosis of C1 ± D4 was 90% in our cases.

Late-onset post-diskectomy tuberculosis at the same operated lumbar level: case report and review of literature

“…In the cervical and upper thoracic spine, increased paravertebral soft tissue might increase the space between the vertebral body and the trachea [15]. These changes along with relevant clinical findings suggest further investigation for the diagnosis.…”

Intramedullary tuberculoma of the conus medullaris: case report and review of the literature

“…7,13 The prognosis for neurologic improvement is good with appropriate therapy. 3,12,14 Medical therapy remains the mainstay of treatment, but when confronted with a progressing neurologic de®cit, surgery may be indicated. In the articles reviewed, 3 ± 5,8 ± 10,15 surgery was performed in the majority of patients mainly to establish the diagnosis.…”

A large tuberculosis abscess causing spinal cord compression of the cervico-thoracic region in a young child

“…Only very few have compared the results of operative and non-operative treatment of TB of the cervical spine in children and adults and the different patterns of healing between the two age groups [17][18][19][20][21][22][23]. The diagnostic difficulty arises because most of the patients with TB of the cervical spine do not show the classic constitutional symptoms such as fever, weight loss, and loss of appetite [24].…”

“…Several reports on tuberculosis of the cervical spine in children have stated principles of management [16,18,19,22,[30][31][32] as follows: (1) obtaining a definitive diagnosis through an appropriate biopsy and culture of the specimen, whenever feasible; (2) institution of appropriate medical management with or without surgical treatment; (3) preservation or restoration of normal neurological function and (4) maintenance of the growing spine stability to prevent subsequent secondary osseous and neurological dysfunction. The combination of raised inflammatory markers, plain X-rays, CT and MRI scans, usually support or is helpful for diagnosis in many cases.…”