Craniovertebral junction tuberculosis: a new comprehensive therapeutic strategy.

OBJECTIVE

To establish a scoring system and management algorithm for patients with diagnosed craniovertebral junction tuberculosis. The specific goals were: 1) to avoid new neurological deficits; 2) to avoid morbidity and compromise in the quality of life associated with prolonged, rigid, cumbersome external immobilization, such as with a sternal occipital mandibular immobilizer brace and halo traction; and 3) to prevent sudden death.

METHODS

All patients diagnosed with craniovertebral junction tuberculosis were studied prospectively over a 3-year period. The initial severity of the disease was evaluated with clinicoradiological grading, and patients were divided into 3 grades. Overall performance status was assessed with disability scoring. Patients with Grade 1 and 2 severity were managed conservatively. Grade 3 patients underwent transoral decompression and posterior fixation. The patients' neurological recovery was evaluated every 4 weeks with disability scoring, along with x-rays, for the initial 3 months and every 2 months thereafter.

RESULTS

Of 71 patients, there were 27 Grade 1, thirty-six Grade 2, and 8 Grade 3 patients. Children and young adults comprised 70% of the study population. All Grade 3 patients underwent early surgery. Five Grade 1 and 2 patients (8%) required delayed surgery for reducible atlantoaxial dissociation. The remaining 58 patients (82%) were effectively managed conservatively. The mean follow-up duration was 18.5 +/- 6.2 months. There was no mortality.

CONCLUSION

Use of our proposed scoring system and management protocol allowed both speedy recovery and early mobilization. All patients had good clinicoradiological outcomes regardless of the grade.