Tuberculosis of the Arch of the Atlas

Corea, J. R.; Tamimi, Tawfik M.

doi:10.1097/00007632-198707000-00022

Cited by 16 publications

(4 citation statements)

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“…Upper C1-C2 spine can be approached by a transoral access; a posterior approach for occiput-C2 fusion may be necessary whenever a major instability is observed. Very proximal involvement, such as infection of the arch of the atlas has been treated successfully by chemotherapy, needle aspiration of the abscess, and halo-brace immobilisation [10]. Craniocervical junction involvement requiring medical chemotherapy is extremely rare, but the anterior approach for decompression and posterior surgical fusion in more severe cases can be the choice [6].…”

Section: Techniquesmentioning

confidence: 99%

Surgical treatment of spondylodiscitis. An update

Guerado

Cerván

2012

International Orthopaedics (SICOT)

195

132

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Concept Spondylodiscitis refers to an infection affecting the intervertebral disk, the vertebral body or the posterior arch of the vertebra being aetiologically, pyogenic, granulomatous (tuberculosis, brucellosis, or fungal infection) or parasitic. Diagnosis Spondylodiscitis diagnosis is based on clinical symptoms, a combination of erythrocyte sedimentation rate with C-reactive protein (CRP) tests and, less useful, leukocytosis. Blood culture is also a very cost-effective method of identifying organisms. Plain radiographs are useful, however changes may take several months to appear. Radionuclide tests are currently less used; nevertheless, fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) shows encouraging results particularly when magnetic resonance images (MRI) are unconvincing in the distinction between degenerative changes and infection. MRI with gadolinium enhancement is the choice for image diagnosis. Management Medical management is usually the basis for treatment, alone or in combination with surgery. Surgical approach, either by endoscopy or open, is indicated for biopsy when clinical evolution is unsatisfactory and no micro-organism has been isolated, and also whenever a root, spinal cord or dural compression is seen on MRI; spinal instability or severe deformity are also clear indications for surgical treatment. Less invasive surgery either CT-scan guided or, particularly, by endoscopy has good results. However open surgery is still the standard. The anterior approach allows for anterior disc and bone debridement. The posterior approach is indicated when posterior elements are involved or in the presence of an epidural abscess. Although good results have been claimed, the use of instrumentation in the presence of an infected focus is controversial, as the use of cages or BMPs are.

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Section: Techniquesmentioning

confidence: 99%

Surgical treatment of spondylodiscitis. An update

Guerado

Cerván

2012

International Orthopaedics (SICOT)

195

132

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“…Especially when treating patients with vertebral artery variation and transpedicular malformations, operating would be difficult, high-risk, and intraoperative surgery could easily lead to vertebral artery injury, or even respiratory failure and sudden death. The main treatment for the upper cervical spine was plaster immobilization, halo-device fixation 6 …”

Section: Discussionmentioning

confidence: 99%

“…These patients had to undergo surgery treatment. At present the main treatments of upper cervical tuberculosis are transoral debridement surgery, lesion drainage, 6 and fusion with bone graft with the protection of a halo-vest, and other minimally invasive surgery. The anterior approach or minimally invasive surgery could not provide strong fixation and had a certain risk of cross-infection.…”

mentioning

confidence: 99%

Anterior Cervical Retropharyngeal Debridement Combined With Occipital Cervical Fusion to Upper Cervical Tuberculosis

Xing

Gao²,

Gao³

et al. 2016

SPINE

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“…Cervical lesions are extremely rare. Tuberculosis of the posterior arch of atlas [8] is included under craniovertebral tuberculosis. Unlike classical pott's spine, posterior spinal tuberculosis commonly involves one vertebral arch only.…”

Section: Epidemiologymentioning

confidence: 99%

Posterior Spinal Tuberculosis: A Review

Kumar¹

2017

Mycobact Dis

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Natural history of posterior spinal tuberculosis has been described. Classifications of the posterior spinal tuberculosis disease process and principles of management based upon the clinical behavior of the disease has been highlighted and emphasized. A thorough review of literature was conducted with the aim to provide the clinicoradiological correlation of the natural history of posterior spinal tuberculosis in described. Management strategy is developed based upon the severity of the clinical behavior of the disease. In anterior spinal tuberculosis, motor fibers are compressed first as they are placed anterior to the sensory tracts in the spinal cord. The sensory fibers are therefore involved in late stages. Ironically, in posterior spinal tuberculosis when compression is predominantly from the posterior aspect of the cord, we again find that motor fibers are involved prior to the sensory fibers. This is in contradiction to the general belief. It is difficult to offer any simple explanation to this apparent paradox. In general, motor fibers are considered more susceptible to pressure effect, whereas sensory fibers are more susceptible to ischemia.That is why in compression paraplegia, signs and symptoms of motor loss appear prior to the sensory loss, as collaterals prevent ischemia for quite some times. In posterior spinal tuberculosis when compression is from the posterior aspect of the cord, at first pressure is exerted on the column of cerebrospinal fluid (CSF) surrounding the cord and gets transmitted to the ligamentum denticulatum. Motor fibers in the close vicinity, get pulled and show early involvement. Secondly, in compression from the posterior aspect of the cord, the cord is displaced anteriorly and anteriorly placed motor fibers are compressed against the anterior wall of the bony spinal canal causing early motor fiber functional loss. Therefore similar classification of paraplegia predominantly based upon the progressive motor weakness is valid for paraplegia noted following posterior spinal tuberculosis. Neurological deficit grading based management is developed. Grade 1 and 2, conservative treatment, grade 3, gray zone and grade 4, operative treatment is emphasized. The five stages of natural history of tuberculosis of spine have been developed from the clinician's point of view. However, indications of surgery are different than what are described for the anterior spinal tuberculosis. Principles of management with role of rest, braces, chemotherapy and surgery are discussed. Management of posterior spinal tuberculosis of spine, in general, it is no different than management of soft tissue tuberculosis, in HIV negative or positive patients. Role of surgery is very different than anterior spinal tubercolosis. Management of posterior spinal tubercular paraplegia, is simple, logical, efficient and easy to understand and remember by any orthopedic/treating surgeon.

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Tuberculosis of the Arch of the Atlas

Cited by 16 publications

References 0 publications

Surgical treatment of spondylodiscitis. An update

Surgical treatment of spondylodiscitis. An update

Anterior Cervical Retropharyngeal Debridement Combined With Occipital Cervical Fusion to Upper Cervical Tuberculosis

Posterior Spinal Tuberculosis: A Review

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