Cervicomedullary Junction Tuberculosis with Atlantoaxial Dislocation: a Case Report and the Role of Surgery in the Atlantoaxial Tuberculosis Treatment

Abstract

The author reports a rare case of a 51-year-old female with C1-2 tuberculosis and dislocation presented with complained neck pain and a rapidly progressive neurological deficit. The patient underwent posterior decompression, debridement, tissue biopsy and occipitocervical fusion because of clinical worsening during admission and received anti-tuberculous chemotherapy continued for12 months. Clinical symptoms and x-ray imaging of the cervical spine were performed to evaluate the therapeutic outcome. The patient was followed up until the radiographic improvement of bone healing. Completed resolution of pain was observed in the third month, followed by normal activity in the sixth month. Although the management of cervicomedullary junction tuberculosis has remained controversial and the conservative treatment has a good prognosis, but the surgery still has a role in a patient with neurological deficit, atlantoaxial instability, failure after conservative treatment or uncertain diagnosis and require tissue biopsy. The insidious symptoms of severe neurological complications and sudden death are due to cervicomedullary compression, and the treatment is therefore different from the lesion at another spine level. However, early diagnosis and treatment are necessary to prevent the serious complications of the disease.