Abstract
Craniovertebral tuberculosis accounts for 5% of all cases of tuberculosis and is the commonest infective pathology affecting this region. There are very few published reports discussing the presentation and management of this complex pathology.
30 cases of craniovertrebral tuberculosis treated between 1989–97 were reviewed retrospectively. The average age was 24 years (range 6 – 42 years) with a follow up of 41 months (range 36 – 48 months). Two main groups on the basis of atlantoaxial stability. 18 (60%) had an unstable atlantoaxial articulation and of these 12 (66%) had a fully reducible AAD in extension. 17 patients (56%) had varying degrees of neurological deficit with lower limb spasticity being the commonest.
Antituberculous chemotherapy, skeletal traction in extension and prolonged bracing with moulded philadelphia collar were main stays of conservative treatment. Surgery in the form of posterior occipito cervical arthrodesis was needed in 13 patients (43%) and indications included incompletely reduced AAD, non resolving neurological deficit and persistent instability despite 6 weeks in traction.
There was 93% success rate with resolution of infection (range 4 – 8 months) and improvement in neurological deficit 2 patients had incomplete neurological recovery and required 2nd stage anterior transoral odontoidectomy. Management strategies based on the presence or absence of instability and neurological deficit can give a very satisfactory outcome with judicious combination of drug therapy, bracing and surgical decompression with fusion.
The abstracts were prepared by Mr Simon Donell. Correspondence should be addressed to him at the Department of Orthopaedics, Norfolk & Norwich Hospital, Level 4, Centre Block, Colney Lane, Norwich NR4 7UY, United Kingdom.
