Cervical tuberculosis associated with cervical pain and neurologic deficit: a case report and literature review |
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Authors: | Lei Wang Limin Liu Yueming Song Fuxing Pei Hao Liu |
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Affiliation: | 1. School of Exercise Science, Faculty of Health Sciences, Australian Catholic University, PO Box 456, Virginia, Queensland 4014, Australia;2. School of Mechanical Engineering, Faculty of Engineering, Computer and Mathematical Sciences, The University of Adelaide, Adelaide, South Australia 5005, Australia;1. Department of Orthopaedics, Mount Sinai School of Medicine, 5 E. 98th St, New York, NY 10029, USA;2. Department of Orthopaedics, Lenox Hill Hospital, 100 East 77th St, New York, NY 10075, USA;1. Department of Neurosurgery, Wooridul Spine Hospital, 47-4 Chungdam-dong, Gangnam-gu, Seoul 135-100, Republic of Korea;2. Department of Cardiology, Sejong Hospital, Sosabon-dong Sosa-gu, Bucheon-si Gyeonggi-do, 420-050, Republic of Korea;3. Department of Gynecology and Obstetrics, Presbyterian Medical Center, Junghwasandong 1-ga, Wansan-gu, Jeonju-si, Jeollabuk-do, 560-832, Republic of Korea;4. Division of Cardiology, Gachon University of Medicine and Science, Gil Hospital, 1198, Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea;1. Scientific Council of Orthopedics, Bab Almuadham 5116, Baghdad, Iraq;2. Spine Health Unit, Orthopedics Department, Bab Almuadham 5116, Baghdad, Iraq;3. Neurological Institute, Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Ave. S-41, Cleveland, OH 44195, USA;1. Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University, School of Medicine, Medical Center East – South Tower, Suite 4200, Nashville, TN 37232, USA;2. Department of Psychology, Washington DC VA Medical Center, 50 Irving St, NW, Washington, DC 20422, USA;3. Department of Orthopaedic Surgery, Johns Hopkins Medicine, 601 N. Carolina St, Baltimore, MD 21287, USA;4. Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, 600 N. Wolfe St, Baltimore, MD 21287, USA |
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Abstract: | 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. |
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Keywords: | Cervical spine Tuberculosis Spinous process Laminae Atlantoaxial luxation Cervical stability |
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