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[Suboccipital Pott's disease].

J Stecken1, H Boissonnet, L Manzo

  • 1Service de Neurochirurgie, Centre Hospitalier Régional, Orléans-La Source.

Neuro-Chirurgie
|January 1, 1987
PubMed
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This case report details sub-occipital Pott's disease, a rare spinal tuberculosis affecting the upper cervical spine. Early diagnosis and combined surgical and medical treatment are crucial for managing this severe condition.

Area of Science:

  • Neurology
  • Orthopedic Surgery
  • Infectious Diseases

Background:

  • Pott's disease, a form of tuberculosis affecting the spine, can manifest in the sub-occipital region, leading to severe neurological deficits.
  • Sub-occipital Pott's disease is rare, presenting diagnostic and therapeutic challenges due to its location and potential for rapid progression.

Observation:

  • A 26-year-old male presented with chronic cervical pain, neck stiffness, dysphagia, and neurological deficits including left hypoglossal nerve paralysis and hemiparesis.
  • Radiological imaging revealed atlanto-axial subluxation, basilar impression, retropharyngeal mass, epidural lesion at C2-C4, and a tuberculous lesion in the right lung apex.
  • Acid Fast Bacilli were positive in gastric secretions and retropharyngeal mass aspirate, confirming spinal tuberculosis.

Findings:

Related Experiment Videos

  • The patient underwent skull traction for reduction, followed by occipito-cervical arthrodesis using plates, and immobilization with a minerva jacket and collar.
  • Literature review of 70 cases highlights common symptoms like cervical pain (98%), neck stiffness (82%), and radiological findings such as atlanto-axial subluxation (68%) and prevertebral soft tissue thickening (77%).
  • Therapeutic strategies include prolonged antituberculous chemotherapy, early reduction of subluxations, and surgical fusion for significant osteolytic lesions.

Implications:

  • This case underscores the importance of considering spinal tuberculosis in patients with sub-occipital symptoms and neurological deficits.
  • Aggressive management involving early surgical intervention and comprehensive antituberculous therapy is essential for favorable outcomes.
  • Further research into optimal surgical techniques and management of associated abscesses is warranted.