Craniocervical tuberculosis: protocol of surgical management

Area of Science:

• Neurosurgery
• Infectious Diseases
• Spinal Surgery

Background:

• Craniovertebral junction tuberculosis (CVJ-TB) is a rare manifestation of tuberculous spondylitis, affecting 0.3-1% of patients.
• Current treatment lacks standardized guidelines, ranging from conservative care to radical surgery.

Purpose of the Study:

• To establish an effective management strategy for Craniovertebral junction tuberculosis (CVJ-TB).
• To correlate clinical presentation, radiological findings, and treatment outcomes.

Main Methods:

• A cohort of 25 patients with CVJ-TB treated over 8 years.
• Patients were graded by disability (I-IV), with assessment of atlantoaxial dislocation (AAD), bony destruction, and abscess formation.
• Management involved 18 months of antituberculous therapy (ATT) combined with conservative stabilization, transoral decompression with posterior fusion, or direct posterior fusion based on clinical and radiological response.

Main Results:

• Patients in Grades I and II maintained neurological status; Grade III improved. Seven of nine Grade IV patients recovered, one improved.
• Significant improvement in neck pain across all grades.
• One mortality in a Grade IV patient with respiratory compromise due to aspiration pneumonitis post-surgery.

Conclusions:

• A tailored management protocol for CVJ-TB, integrating 18 months of ATT, is effective.
• Conservative neck stabilization for minor deficits (Grades I-II).
• Anterior decompression and posterior fusion for severe deficits (Grades III-IV) with fixed AAD or bone destruction; direct posterior fusion for reducible AAD.