Abstract
Tuberculous spondylitis has become relatively rare in recent years. Furthermore, the incidence of tuberculous spondylitis involving the atlas and axis comprises only 0.3% of all tuberculous spondylitis. We successfully treated a patient with tuberculous spondylitis of the atlas and axis without pulumonary lesion.A 29-year-old female, suspected of a cervical disc hernia, was refered to us because conservative treatment induced little improvement. She had symptoms indicating cervical tuberculous spondylitis, such as febricula, malaise, neck pain, headache, and dysphagia. Serological exams indicated acute inflammation (ESR: 95mm/h, CRP: 4.6mg/dl). Roentgenograms of her chest and cervical spine did not show any pathological findings. However, CT revealed the pathological fracture of the atlas and MRI revealed fluid collection around the atlanto-axial region and middle thoracic spine. Needle aspiration of cervical lesion was performed under CT guide. Tuberculous infection was determined using the PCR method. Clinical symptoms subsided and ESR and CRP were reduced to normal range 4 weeks after the start of antituberculous medications. After 14 weeks, we confirmed thebone union of the pathological fracture of the atlas and disappearance of the abscess by MRI.
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