Tuberculosis of the Craniovertebral Junction: Is Surgery Necessary?

Gupta, Sunil; Mohindra, Sandeep; Sharma, Bhawani S.; Gupta, Rahul; Chhabra, Rajesh; Mukherjee, Kanchan Kumar; Tewari, Manoj Kumar; Pathak, Ashis; Khandelwal, Niranjan; Suresh, Narain M; Khosla, Virender K.

doi:10.1227/01.neu.0000215950.85745.33

Cited by 55 publications

(73 citation statements)

References 12 publications

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“…Literature is quite divided on management of patients with tuberculosis involvement of the craniovertebral junction [4,7,[9][10][11][12]14]. Some people recommend conservative treatment only [1,2,5,11,22], others recommend surgery in all patients [3,6,8,23].…”

Section: Discussionmentioning

confidence: 99%

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Tuberculosis of the craniovertebral junction

et al. 2012

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Purpose Tuberculosis (TB) of craniovertebral junction (CVJ) occurs in 1-5 % of cases of TB spondylitis. This can be a life-threatening condition due to mass effect of infective process or resultant instability. Surgical indications for TB of CVJ are not clear from literature. Methods We have reviewed all the patients with TB of CVJ admitted at our center between 2005 and 2010. Results There were 15 patients including 10 males and 5 females. Average age was 38 years and average duration of symptoms was 8 months. All patients were started on multidrug antituberculous chemotherapy and skull traction. Those patients who failed to respond in 4-6 weeks and had persistent instability or neurological deficit were offered surgery. Rest was treated conservatively by immobilisation or traction. All five patients who were surgically treated had occipitocervical fusion (OCF) with titanium screws and plate/rod construct combined with posterior decompression if needed. Only one patient needed anterior surgery in addition to OCF at a later stage. All patients improved neurologically whether they were treated surgically or conservatively. Only difference was that surgically treated patients had earlier pain relief, mobilisation, neurological improvement and lesser complications. Conclusion We recommend that all patients with TB of CVJ with instability and neurological compromise, who fail to respond to 4-6 weeks of antituberculous chemotherapy and skull traction should be offered occipitocervical fusion with or without posterior decompression. Anterior surgery will be needed only in those few cases who do not improve neurologically after OCF.

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Section: Discussionmentioning

confidence: 99%

“…Others come to the conclusion that surgery is not necessary in craniocervical junction tuberculosis [14], since finally all patients will clinically heal as well as radiologically under conservative treatment.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis of the craniovertebral junction

et al. 2012

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“…Diagnosis may be difficult and management can be challenging, requiring different treatment modalities depending on the clinical symptoms or radiological features. Treatment options are also controversial without well-defined guidelines, including a conservative approach (anti-tuberculosis medication and external fixation), relatively simple surgery (posterior fusion and fixation), or radical surgery (debridement, decompression and stabilization) [1][2][3][4][6][7][8][9][10][11][12][13][15][16][17][18]20) . The authors present a case of CVJ tuberculosis with atlantoaxial dislocation (AAD) and retropharyngeal abscess.…”

Section: Introductionmentioning

confidence: 99%

Craniovertebral Junction Tuberculosis with Atlantoaxial Dislocation : A Case Report and Review of the Literature

Lee

Cho

et al. 2007

J Korean Neurosurg Soc

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“…13 In cranio-vertebral junction tuberculosis, despite extensive erosion of the clivus, C1 and C2, and spinal cord compression, the patients can effectively be managed with antituberculosis therapy alone. 9,16 We could deduce that significant cord compression and spinal extension of abscess were significantly associated with outcome in cervical spine tuberculosis. These observations indicated that extensive tuberculous involvement of the spinal cord was responsible for the poor outcome.…”

Section: Discussionmentioning

confidence: 94%

Outcome assessment in conservatively managed patients with cervical spine tuberculosis

et al. 2014

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Study design: Cervical spine tuberculosis is a relatively less frequent form of spinal tuberculosis. Cervical spine tuberculosis has a greater propensity to involve the spinal cord and results in major sensory motor deficit. In this prospective study, we aimed to evaluate the clinical and imaging predictors of outcome in conservatively managed patients. Methods: In this study, 42 patients of cervical spine tuberculosis were included. Patients were subjected to a detailed clinical evaluation and magnetic resonance imaging. Patients were treated with antituberculosis treatment and were followed up for 18 months. The Modified Barthel index (MBI) was used to assess the disability. Good outcome was defined as MBI 412 and poor outcome as MBI p12. Clinical and imaging characteristics were used to analyze the predictors of outcome, using univariate and multivariate analysis. Results: Four (9.5%) patients required surgery. Data from 38 patients, who were conservatively managed, were analyzed for predictors of outcome. Among conservatively managed patients, at presentation, 29 patients had an MBI score of p12. At 18 months, the majority of patients (81.6%) had a good outcome. On univariate analysis, a duration of illness 43 months, a major motor deficit, bladder involvement, flexor spasms, significant cord compression and spinal extension of the abscess were significantly associated with a poor outcome. However, on multivariate analysis significant cord compression (P ¼ 0.003) and spinal extension (P ¼ 0.02) showed a significant correlation with a poor outcome. Conclusion: Medical management was effective in cervical spine tuberculosis. Patients with significant cord compression and spinal extension of the abscess showed poorer outcome.

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Tuberculosis of the Craniovertebral Junction: Is Surgery Necessary?

Cited by 55 publications

References 12 publications

Tuberculosis of the craniovertebral junction

Tuberculosis of the craniovertebral junction

Craniovertebral Junction Tuberculosis with Atlantoaxial Dislocation : A Case Report and Review of the Literature

Outcome assessment in conservatively managed patients with cervical spine tuberculosis

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