[Pott's disease of the upper cervical spine (three cases and literature review)].
BACKGROUND
Sub-occipital Pott's disease is rare, but dangerous.


OBJECTIVE
To recall diagnostic aspects and spatially the neuroradiological ones of sub-occipital Pott's disease.


METHODS
We describe three patients with sub-occipital Pott's disease followed in our department from 2002 to 2007.


RESULTS
There were two women and one man (mean age at onset: 48 years). The early clinical picture was non specific. Exploration, in addition to standard radiographies included a computerized Tomography (CT) (n=2) and MRI (n=1 and n=3). The diagnosis was confirmed histologically on a biopsy of the abscess (n=1), a bacteriological evidence (n=2) and retained thanks to argument presumption (n=3). The treatment was based on quadruple antituberculous chemotherapy with external traction (n=2 and n=3) associated with urgent surgery (n=1) because of the worsening of the neurological complications. The evolution was fatal (n=1) and positive (n=2 and n=3).


CONCLUSIONS
Tuberculosis should be suspected in patients with chronic torticollis and residing in an area when tuberculosis is endemic. Medical treatment is based on a quadruple antituberculosis chemotherapy with traction in the presence of atlanto-axial instability. Surgery is reserved in case of neurological worsening or persistent instability.
Service d'orthopédie traumatologie, Hôpital Charles Nicolle Tunis.
Mohamed
M
Bouabdellah
Ramzi
R
Bouzidi
Skander
S
Kammoun
Fredj
F
Mohamed
Karim
K
Amara
Lilia
L
Chaabouni
Mondher
M
Kooli
Mongi
M
Zlitni
D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000382:microbiology* / Q000601:surgery; D019299:Decompression, Surgical; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008297:Male; D014399:Tuberculosis, Spinal / Q000175:diagnosis* / Q000628:therapy
D000995:Antitubercular Agents