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Published on: October 25, 2024
Pediatric cranio-vertebral junction tuberculosis: management and outcome
Anant Mehrotra1, Kuntal Kanti Das, Anup P Nair
1Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Summary
Cranio-vertebral junction tuberculosis (CVJ TB) is rare in children. Early diagnosis with CT and MRI, followed by conservative or surgical management based on neurological grade, leads to significant improvement.
Area of Science:
- Neurosurgery
- Pediatric Infectious Diseases
- Spinal Tuberculosis
Background:
- Cranio-vertebral junction tuberculosis (CVJ TB) is a rare manifestation of spinal TB, representing 0.3-1% of cases.
- Early diagnosis and management are crucial to prevent severe neurological deficits, especially in pediatric patients.
- Established management protocols for pediatric CVJ TB are limited.
Purpose of the Study:
- To evaluate the clinical and radiological features of pediatric CVJ TB.
- To assess the efficacy of a management protocol based on neurological grading.
- To analyze outcomes in children with CVJ TB.
Main Methods:
- A cohort of 29 pediatric patients with suspected CVJ TB was retrospectively analyzed.
- A novel clinical grading system was developed and applied to assess neurological status.
- Computed tomography (CT) and gadolinium-enhanced magnetic resonance imaging (MRI) were used for radiological evaluation.
- Management strategies (conservative vs. surgical) were tailored to the patient's neurological grade.
Main Results:
- The study included 18 females and 11 males aged 4-18 years (mean age 9 years).
- 11 patients had mild neurological deficits (grades 1-2), while 18 had severe deficits (grades 3-4).
- A predominantly conservative approach was used for lower grades, with surgery reserved for higher grades.
- All patients demonstrated significant neurological improvement during a mean follow-up of 2.7 years.
Conclusions:
- High clinical suspicion for CVJ TB is warranted in pediatric patients presenting with neck pain, stiffness, and elevated ESR.
- CT and MRI with contrast are essential for diagnosis and management planning.
- Conservative management is effective for mild cases, while severe cases may require initial conservative treatment followed by surgery if necessary.
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