C2 spondylitis TB treatment by only posterior approach

Abstract

Abstract Tuberculosis infection of the second cervical spine is a very rare case and has an incidence rate of only 1 in 100,000; nevertheless, it could result in grave morbidities. In the present study's case, a 26-year-old woman came to the our hospital complaining about stiffness and pain in the neck and other symptoms such as weakness of the left hand and leg as well as positive long tract signs. C-spine MRI revealed a mass with bone destruction around C1–4, which was similar in appearance with the tumor as well as indicated the possibility of atlantoaxial dislocation. Surgery was planned to be conducted in two stages for this patient: (a) first, through the posterior approach by occipito-cervical fusion with laminectomy biopsy and (b) via a transoral approach. However, since the biopsy revealed that tuberculosis caused the lesion, the second stage of the surgery was canceled, and the patient was treated with anti-TB drugs for 9 months. Follow-up evaluation showed significant motoric and sensory improvement in the strength of the left hand and improvement in foot function even though there was still some degree of gait impairment which was tolerable for the patient. To conclude, TB treatment for C2 lesion can also be handled via the posterior approach surgery with good results, especially for cases with atlantoaxial dislocation.