Abstract
High cervical tuberculosis is a rare condition, occurring in 0.3% to 1% of patients with tuberculous spondylitis. Until a more obvious and potentially dangerous complication develops, it is often overlooked or misdiagnosed. We review the presentation, management and outcome of patients with atlanto-axial tuberculosis.
The case notes and radiographs of five patients with atlanto-axial tuberculosis were reviewed and they were recalled for clinical assessment. The mean age of patients was 30 years (16 to 54). The mean time from presentation to diagnosis was 5.6 months (3 to 12). All patients presented with neck pain and stiffness, which three ascribed to previous trauma. Two patients had neurological deficit. Three had tuberculosis at other sites. All patients had prevertebral swelling on plain lateral cervical spine radiographs and a collection anterior to C1/2 on CT scan or MRI. Three of these patients underwent surgery, one for anterior abscess drainage and diagnosis, one for stabilisation and one for non-contigious spinal involvement. All received four-drug antituberculous medication for at least 6 months. A single patient was HIV positive. All patients did well, with complete resolution of neurological symptoms and instability and good recovery of range of motion.
Atlanto-axial tuberculosis is rare but carries the risk of instability and neurological compromise. Particularly in endemic areas, a high index of suspicion is necessary when patients present with neck pain. Non-operative management, with bracing and antituberculous agents, is adequate, with surgery indicated for instability.
Secretary: Dr H.J.S. Colyn, Editor: Professor M.B.E. Sweet. Correspondence should be addressed to SAOA, Box 47363, Parklands, Johannesburg, 2121, South Africa.
