Cervical spine tuberculosis
Maher Teka1,&, Hazem Ben Ghozlen1, Akram Yassine Zaier1, Majdi Ben Hnia1, Nader Naouar2, Faouzi Abid1
1Department of Orthopaedics and Trauma,Taher Sfar Hospital of Mahdia, Mahdia, Tunisia, 2Department of Orthopaedics and Trauma, Sahloul Hospital of Sousse, Sousse, Tunisia
Maher Teka, Department of Orthopaedics and Trauma,Taher Sfar Hospital of Mahdia, Mahdia, Tunisia
Tuberculosis of the cervical spine differs from other vertebral localizations
by its extreme rarity, the clinical images are very diversified, the
radiological measurements allow a good diagnostic orientation and specifically
which allows a multi-planar study of the various lesions. Only bacteriological
evidence can confirm the diagnosis. The treatment is based on a 12-month
antituberculosis multidrug therapy and much debate upon the surgical
indication. In our case, the patient presented with bilateral cervicobrachialgia
pain on examination at the mobilization of the cervical spine. A standard
X-ray, a cervical CT scan, and a cervical MRI were performed, showing
a C4 vertebral body compression of a probably infectious origin. The
the diagnosis of a Cervical Pott's Disease that had been treated with
anterior arthrodesis and TB treatment with rehabilitation, the patients'
neurological symptoms improved, and he was doing well.
The most common extra-pulmonary skeletal form of tuberculosis is
within the spine, with a predilection for the thoracic and lumbar
Tuberculosis of the cervical spine is distinguished from other
vertebral localizations by its extreme rarity, representing approximately
spinal TB cases [1-3]. Therefore, its clinical and radiological
semiology is quite distinctive, as the cervical spine can be affected
by lesions that lead to instability and neurological deficits,
and its prognosis is conditioned by the risk of bulbo-medullary
compression. The conduct
the cervical spine TB can involve a variety of interventions, ranging
from TB treatment to surgery, although chemotherapy is the mainstay
of the treatment
Patient and observation
Patient K.R., 42 years old, without any particular pathological antecedents, who has had bilateral cervicobrachialgia for the past 9 months without any sensorimotor deficit, evolving in an unquantified weight loss context. On clinical examination, there was noticeable pain on the mobilization of the cervical spine. Standard radiography showed osteolysis with compression of the body of C4 (Figure 1). Magnetic resonance imaging confirmed the CT scan data and revealed a compression of the C4 vertebral body with epiduritis, or spinal epidural abscess and infiltration of the paravertebral soft tissues, suggesting primarily an infectious origin (Figure 2). The biopsy confirmed the diagnosis of active tuberculosis. The patient was treated with an anterior arthrodesis (Figure 3) and quadruple tuberculosis chemotherapy for 12 months.
Post-rehabilitation showed improvement in patients' neurological symptoms, and his wellbeing with no signs of tuberculosis recurrence.
The tuberculosis localization in the cervical spine is very rare
. The clinical pictures are varied and can range
from isolated neuralgia cervicobrachial to tetraplegia .
Weight loss, night fever, cervical lymph adenopathies and retro-pharyngeal
abscesses should be brought to the attention of the clinician [4,5].
Radiological data is propitious for diagnosis, but CT and MRI
scans allow a better definition of bone and soft tissue abnormalities.
for a precise
multi-planar study MRI is more accurate than a CT scan [3,6,7],
it achieves a better tissue differentiation, allows a demonstration
of the marrow in relation to the envelopes, the study of the spinal
disc, and the
tissue surrounding of the spine. It can also detect the earliest
signs of disco-vertebral tubercular disease at an infra-radiological
stage on both
regular X-rays and CT scans [3,6,7].
Only bacteriological proof, either by biopsy of pre-vertebral soft tissues or
by direct access to the focal point, can confirm the diagnosis
but sometimes the presumptive diagnosis is based on epidemiological,
clinical, and radiological evidence. The treatment is based on
poly anti-tuberculosis chemotherapy lasting approximately 12 months.
The surgical indications
still much controversial [7,9].
The persistence of bone destruction with spinal instability is
an indicator of surgical intervention. This treatment must be urgent
in given the aggravation
of a probable spinal cord compression . Healing results
in weight gain, biological normalization, and bone reconstruction
with the fusion of bone lysed structures on X-ray.
The cervical localization of Pott's disease is extremely rare. The clinical and radiological findings are often deceptive, requiring the use of modern imaging equipment to enable an accurate diagnosis of anatomical lesions. Treatment is based on antibiotic therapy and immobilization of the cervical spine.
The authors declare no competing interests.
Maher Teka: data collection, interpretation and drafting the case report; Hazem Ben Ghozlen:data collection, interpretation anddrafting the case report;Akram Yassine Zaier:data collection and revising the case report; Majdi Ben Hnia:data collection and revising the case report; Nader Naouar:data collection and revising the case report; Faouzi Abid: Supervising and revising the case report.All the authors have read and agreed to the final manuscript.
Figure 1: standard radiography showed osteolysis with compression of the vertebral body of C4
Figure 2: magnetic resonance imaging revealed a compression of the C4 body with epiduritis, or spinal epidural abscess, and infiltration of the paravertebral soft tissues, suggesting primarily an infectious origin
Figure 3: anterior arthrodesis
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