title: Craniovertebral tuberculosis: a retrospective review of 13 cases managed conservatively.
abstract: METHODS
  Retrospective review of 13 cases with craniovertebral tuberculosis treated conservatively.
  
  
  OBJECTIVE
  To evaluate the results of conservative treatment of craniovertebral tuberculosis and compare with the literature.
  
  
  BACKGROUND
  Craniovertebral tuberculosis is a rare entity even in endemic countries, and there is no consensus in the literature regarding conservative or surgical management for the same. Reports range from radical surgery to totally conservative approach. We report our experience in treating such patients conservatively.
  
  
  METHODS
  A retrospective review of 13 patients diagnosed with craniovertebral tuberculosis was performed. All patients were treated conservatively with cervical traction for initial 3 months followed by a brace along with multidrug antitubercular drugs for 18 months.
  
  
  RESULTS
  All patients responded favorably to conservative treatment. Follow-up averaged 43 months (range, 16-65 months). No patient deteriorated neurologically. All patients had symptomatic improvement. Failure to reduce atlantoaxial dislocation/lateral subluxation of the dens completely was seen in 2 cases.
  
  
  CONCLUSIONS
  We think that all patients with craniovertebral junction tuberculosis can be managed adequately using conservative means regardless of the extent of bony destruction with a good patient outcome. Surgery should be reserved for only a selective few where diagnosis is in doubt and there is initial severe or progressive neural deficit with/without respiratory distress in presence of documented mechanical compression and documented dynamic instability following conservative treatment.
authors.affiliation: Department of Orthopedics, UCMS and GTB Hospital, Delhi, India. mchadha@hotmail.com
authors.forename: Manish
authors.initials: M
authors.lastname: Chadha
authors.forename: Anil
authors.initials: A
authors.lastname: Agarwal
authors.forename: Arun Pal
authors.initials: AP
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D001368:Axis, Cervical Vertebra / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology*; D001270:Cervical Atlas / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D008297:Male; D017703:Retropharyngeal Abscess / Q000150:complications / Q000382:microbiology / Q000503:physiopathology; D012189:Retrospective Studies; D012886:Skull / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology*; D013131:Spine / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D014143:Traction / Q000379:methods; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D021801:Zygapophyseal Joint / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology
chemical_list: D000995:Antitubercular Agents