title: Pediatric cranio-vertebral junction tuberculosis: management and outcome.
abstract: BACKGROUND
  Tuberculosis (TB) of the cranio-vertebral junction (CVJ) is a rare condition, accounting for 0.3 % to 1 % of all cases of spinal TB. Early diagnosis and treatment are important in preventing long-term neurological sequelae. Management protocol of this rare site of TB is yet to be conclusively established. This holds particularly true for pediatric age group in which this condition is infrequently encountered.
  
  
  METHODS
  A total of 29 consecutive pediatric patients presented to the Department of Neurosurgery at Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, from January 1997 to October2011 with clinical and/or radiological features suggestive of CVJ TB. A clinical grading system to evaluate the neurological status was developed, and all patients were evaluated using this scoring system. Patients were radiologically evaluated with computed tomography (CT) of CVJ and magnetic resonance imaging (MRI) with gadolinium enhancement. These cases were managed according to their grade and followed up.
  
  
  RESULTS
  Out of a total of 29 cases, 18 were females and 11 males. Age range was 4 to 18 years with mean age 9 ± 3.8 years. The follow-up period ranged from 2 months to 7.5 years with mean follow-up of 2.7 years. Eleven cases were of grades 1 and 2, and 18 cases were of higher grade (grades 3 and 4). Predominantly conservative approach was utilized in cases with better clinical status, and grade (grades 1 and 2) and surgical intervention was needed in the more severe grades. All cases had significant improvement at the last follow-up.
  
  
  CONCLUSIONS
  One needs to have a high index of suspicion of CVJ TB if one encounters a case with neck pain, neck restriction, and raised erythrocyte sedimentation rate. CT CVJ and MRI with gadolinium contrast enhancement are the investigations of choice for both establishing a diagnosis and planning the management. For cases with mild neurological deficit, conservative approach would work for majority of cases, and for severe cases, initial conservative approach may be tried, failing which surgical intervention would be needed.
authors.affiliation: Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Anant
authors.initials: A
authors.lastname: Mehrotra
authors.forename: Kuntal Kanti
authors.initials: KK
authors.lastname: Das
authors.forename: Anup P
authors.initials: AP
authors.lastname: Nair
authors.forename: Rajan
authors.initials: R
authors.lastname: Kumar
authors.forename: A K
authors.initials: AK
authors.lastname: Srivastava
authors.forename: Rabi Narayan
authors.initials: RN
authors.lastname: Sahu
authors.forename: Raj
authors.initials: R
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D001268:Atlanto-Axial Joint / Q000473:pathology* / Q000601:surgery; D002574:Cervical Vertebrae / Q000473:pathology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D008297:Male; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy
chemical_list: D005682:Gadolinium