Atlanto-axial tuberculosis in adults.
Twelve adult patients with confirmed tuberculosis of the atlanto-axial spine are presented and a classification proposed. Stage I has minimal ligamentous or bone destruction and no displacement of C1 on C2; the suggested treatment is transoral biopsy and decompression followed by an orthosis. Stage II has ligamentous disruption and minimal bone destruction but anterior displacement of C1 on C2; treatment involves transoral biopsy and decompression, reduction by halo traction, then a posterior C1-2 fusion. Stage III has marked ligamentous and bone destruction with displacement of C1 forward on C2; the suggested treatment is transoral biopsy and decompression, reduction by halo traction, then fusion from the occiput to C2 or C3. One patient died before treatment started; all the others have gone on to solid union with resolution of any neurological deficit. There has been no evidence of reactivation of disease over an average follow-up of 36 months.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage; D001268:Atlanto-Axial Joint; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D009989:Orthotic Devices; D013166:Spondylitis / Q000145:classification / Q000175:diagnosis / Q000628:therapy; D014394:Tuberculosis, Osteoarticular / Q000145:classification* / Q000175:diagnosis / Q000628:therapy
D000995:Antitubercular Agents