Cervical tuberculous vertebral osteomyelitis: case report and discussion of the literature

We report a case of tuberculous vertebral osteomyelitis of the first and second cervical vertebrae with extensive adjacent soft-tissue involvement and extension into the mediastinum and bilateral flanks. The clinical presentation of tuberculous vertebral osteomyelitis depends on the vertebrae involved. The characteristic syndrome, Pott's disease, reflects the consequence of infection of the lower thoracic and lumbar spine, the most common site of tuberculous vertebral osteomyelitis. Cervical involvement is unusual: tuberculosis affects the cervical vertebrae in approximately 0.03% of all cases. Tuberculosis of the atlas and axis is even more rare. Characteristic symptoms reported on presentation include fever, weight loss, night sweats, and neck pain and stiffness. Patients may have no neurological manifestations, but findings can range from single nerve-root compression to quadriplegia. Abscess may extend into the retropharynx, mediastinum, and posterior triangles and along the epidural space. Computerized tomography and magnetic resonance imaging are the most useful imaging procedures. Therapy should consist of administration of antimycobacterial antibiotics and--if indicated by the degree of subluxation, by neurological signs, or by cervical instability--surgical debridement and stabilization.