Tuberculosis of the craniovertebral junction

Abstract

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. We have reviewed all the patients with TB of CVJ admitted at our center between 2005 and 2010. There were 15 patients including 10 males and 5 females. Average age was 38years and average duration of symptoms was 8months. All patients were started on multidrug antituberculous chemotherapy and skull traction. Those patients who failed to respond in 4-6weeks 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. We recommend that all patients with TB of CVJ with instability and neurological compromise, who fail to respond to 4-6weeks 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.