[Atlanto-axial Pott's disease. Apropos of a case with review of the literature].

INTRODUCTION

A new case of sub-occipital Potts disease is reported.

CASE REPORT

A 26 years old female from Senegal was admitted for cervical pain of three months duration, neck stiffness and left nasal obstruction with Arnold neuralgia. Radiological studies found a C1-C2 rotatory subluxation with an osteolytic erosion of the lateral mass of the atlas and destruction of the left atlanto-axial joint. CT scan and magnetic resonance imaging provided important diagnostic clues. Culture of sinus biopsies showed a mycobacterium tuberculosis. Progressive reduction of the dislocation and immobilization by minerva jacket for six months with prolonged antituberculous chemotherapy provided successful end result.

DISCUSSION

A review of the literature found 95 cases reported since the beginning of this century. The mean age was 20-30 years old. A finding of acid resistant bacilli is necessary for diagnosis and requires culture of gastric secretion, expectoration, retro pharyngeal mass puncture and other upper respiratory tract foci. Radiological signs are discussed. Chemotherapy is the mainstay of treatment with immobilization following reduction of the dislocation when present. The removal of abscess is discussed as well as bone grafting by an anterior or more commonly by posterior approach in case of instability.