Atlanto-axial tuberculosis in adults

Area of Science:

• Orthopedics
• Infectious Diseases
• Neurosurgery

Background:

• Tuberculosis (TB) can affect the atlanto-axial spine, leading to instability and neurological deficits.
• Accurate classification and timely treatment are crucial for managing spinal TB.

Purpose of the Study:

• To propose a classification system for atlanto-axial spine tuberculosis.
• To outline stage-specific treatment protocols for atlanto-axial spine TB.
• To evaluate treatment outcomes and long-term prognosis.

Main Methods:

• Retrospective review of twelve adult patients with confirmed atlanto-axial spine TB.
• Development of a three-stage classification based on bone and ligamentous destruction and C1-C2 displacement.
• Application of tailored surgical and conservative treatment strategies according to disease stage.

Main Results:

• A three-stage classification (I, II, III) was proposed.
• Stage I: Minimal destruction, treated with biopsy, decompression, and orthosis.
• Stage II: Ligamentous disruption with anterior displacement, treated with biopsy, decompression, halo traction, and posterior fusion.
• Stage III: Marked destruction with displacement, treated with biopsy, decompression, halo traction, and occiput-to-C2/C3 fusion.
• One patient died pre-treatment; eleven achieved solid union and neurological recovery.
• Average follow-up of 36 months showed no disease reactivation.

Conclusions:

• The proposed classification effectively stratifies atlanto-axial spine tuberculosis.
• Stage-specific treatment protocols lead to successful outcomes, including solid union and neurological recovery.
• This approach offers a reliable management strategy for spinal tuberculosis with good long-term prognosis.