Tuberculosis of the craniovertebral junction

Area of Science:

• Neurosurgery
• Infectious Diseases
• Orthopedic Surgery

Background:

• Tuberculosis (TB) of the craniovertebral junction (CVJ) is rare, occurring in 1-5% of TB spondylitis cases.
• CVJ TB poses life-threatening risks due to potential mass effect and instability.
• Clear surgical indications for CVJ TB are lacking in current literature.

Purpose of the Study:

• To evaluate the outcomes of surgical versus conservative management for tuberculosis of the craniovertebral junction.
• To establish clearer guidelines for surgical intervention in CVJ TB cases.

Main Methods:

• Retrospective review of 15 patients with CVJ TB treated between 2005 and 2010.
• All patients received multidrug antituberculous chemotherapy and skull traction.
• Surgical intervention (occipitocervical fusion) was considered for non-responders after 4-6 weeks or those with persistent instability/neurological deficit.

Main Results:

• Fifteen patients (10 male, 5 female; average age 38) with CVJ TB were analyzed.
• All patients showed neurological improvement, with surgical cases experiencing earlier pain relief and mobilization.
• Surgically treated patients had fewer complications compared to conservative management.

Conclusions:

• Occipitocervical fusion is recommended for CVJ TB patients with instability and neurological compromise unresponsive to 4-6 weeks of chemotherapy and traction.
• Posterior decompression may be combined with fusion as needed.
• Anterior surgery is reserved for rare cases with persistent neurological deficits post-OCF.