Cervical tuberculosis associated with cervical pain and neurologic deficit: a case report and literature review

Background contextIsolated tuberculosis (TB) of posterior elements of the cervical spine is extremely rare. Only few cases are reported in literature, but none describe isolated spinous process and laminae involvement without TB in any other part of the body.PurposeTo report a case of isolated TB involvement of the spinous process and right laminae of C2 combined with atlantoaxial luxation.Study designA case report of isolated spinous process and right laminae TB of C2 combined with atlantoaxial luxation.Patient sampleA 20-year-old male farmer complained about a 2-month history of aggravating neck pain, a 1-month history of a slowly growing lump at the back of the neck, and numbness and weakness of the right arm that had gradually progressed to involve all the limbs for 2 weeks before presentation.Outcome measuresX-ray and computed tomography of cervical spine and Frankel grading of neural function are included to evaluate the therapeutic efficiency.MethodsComputed tomography scans showed flake-like bony destruction located in the spinous process and at the right laminae of C2. Magnetic resonance imaging (MRI) showed a large swelling posterior to C2 and atlantoaxial luxation-induced distinct compression of the spinal cord. The patient underwent 2 weeks of skull traction and quadruple anti-TB treatment before surgery.ResultsThe patient underwent surgical treatment that included posterior radical debridement, decompression, internal fixation with a screw-rod system from C1 to C4, autologous bone grafting, and fusion. The patient gained normal neural function and returned to work 1 year after surgery.ConclusionsTuberculosis of the posterior elements of the upper cervical spine is very rare and potentially dangerous. Computed tomography and MRI are very useful and important for correct diagnosis. Prompt medical and surgical treatment may avert potential catastrophic event in these cases.