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Updated: Oct 15, 2025

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Cervical spine TB - Current concepts in management.

Ajoy Prasad Shetty1, Vibhu Krishnan Viswanathan1, S Rajasekaran1

  • 1Department of Spine surgery, 76290Ganga Medical Centre and Hospital, Coimbatore, Tamil Nadu, India.

Journal of Orthopaedic Surgery (Hong Kong)
|October 29, 2021
PubMed
Summary

Cervical tubercular disease (CTB) is rare but causes significant neurological deficits. Management principles are similar to other spinal TB, with medical therapy as the cornerstone, and surgery reserved for specific cases.

Keywords:
atlantoaxial tuberculosiscervical tuberculosiscervico-thoracic tuberculosissub-axial cervical tuberculosis

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Area of Science:

  • Spinal Tuberculosis Research
  • Infectious Disease Epidemiology
  • Surgical Management of Spinal Infections

Background:

  • Cervical tubercular disease (CTB) is a rare spinal tuberculosis (TB) manifestation (3-5% of spinal TB).
  • It encompasses atlantoaxial TB (AATB) and sub-axial TB (SACTB), with limited literature and controversial aspects.
  • CTB presents a higher incidence of neurological deficits compared to other spinal TB types.

Purpose of the Study:

  • To comprehensively review the current literature on cervical tubercular disease (CTB).
  • To address key questions and controversies surrounding CTB diagnosis and management.
  • To consolidate evidence on the epidemiology, clinical presentation, and treatment strategies for CTB.

Main Methods:

  • An extensive literature search was conducted on PubMed and Google Scholar using keywords related to cervical, atlantoaxial, sub-axial, and cervico-thoracic tuberculosis.
  • The search was performed on December 2, 2020, identifying crucial questions for review.
  • A total of 41 relevant articles were included after initial screening and full manuscript scrutiny, prioritizing review articles, RCTs, and Level 1 studies.

Main Results:

  • Atlantoaxial TB (AATB) accounts for 0.3-1% and sub-axial CTB (SACTB) for 3% of spinal TB cases.
  • CTB is associated with a significantly higher rate of neuro-deficit than other spinal TB.
  • Surgical approaches for AATB include anterior, posterior, or combined methods (posterior preferred), while SACTB often benefits from anterior approaches, with posterior stabilization as an option.

Conclusions:

  • Medical therapy is the primary treatment for CTB, similar to other spinal TB.
  • Surgery is indicated for severe neurological deficits, significant structural instability, sagittal imbalance, drug resistance, or poor response to medication.
  • Despite its rarity and complexity, cervical tubercular disease generally has favorable long-term outcomes with appropriate management.