Pathogenesis and Staging of Craniovertebral Tuberculosis: Radiographic Evaluation, Classification, and Natural...

Area of Science:

• Orthopedics
• Infectious Diseases
• Radiology

Background:

• Craniovertebral junction (CVJ) tuberculosis (TB) is a complex condition.
• Understanding its pathogenesis is crucial for effective classification and treatment.
• Existing classification systems may not fully capture the disease's progression.

Purpose of the Study:

• To radiographically evaluate the pathogenesis of CVJ tuberculosis infection.
• To propose a modified Lifeso classification system for CVJ TB.

Main Methods:

• Retrospective cohort study of 52 patients with CVJ TB.
• Analysis of clinical presentation, treatment, and radiographic evidence of bone destruction and abscess formation.
• Classification of disease using the Lifeso grading system and bony lesion types.

Main Results:

• Lifeso III lesions were associated with longer symptom duration, abscess formation, spinal cord compression, and involvement of C2 body and atlanto-dental joint.
• Bony destruction was more common in Lifeso III cases, particularly in the atlanto-dental and lateral atlantoaxial joints.
• Neck pain was the most common presentation, followed by myelopathy.

Conclusions:

• Radiologic findings suggest CVJ TB may originate in the periarticular fascia, spreading to adjacent joints.
• A modified Lifeso classification is proposed to better reflect the proposed etiology and radiologic pathogenesis of CVJ TB.