Pott’s disease of the upper cervical spine (three cases and literature review)
Keywords:
Pott's disease, tuberculosis, abscesses, cervical vertebrae, quadriparesisAbstract
Background: Sub-occipital Pott's disease is rare, but dangerous.
Aim : To recall diagnostic aspects and spatially the neuroradiological ones of sub-occipital Pott's disease.
Methods: We describe three patients with sub-occipital Pott's disease followed in our department from 2002 to 2007.
Results: There were two women and one man (mean age at onset: 48 years). The early clinical picture was non specific. Exploration, in addition to standard radiographies included a computerized Tomography (CT) (n=2) and MRI (n= 1 and n=3).
The diagnosis was confirmed histologically on a biopsy of the abscess (n=1), a bacteriological evidence (n= 2) and retained thanks to argument presumption (n= 3). The treatment was based on quadruple antituberculous chemotherapy with external traction (n=2 and n=3) associated with urgent surgery (n= 1) because of the worsening of the neurological complications .The evolution was fatal (n= 1) and positive (n=2 and n=3).
Conclusion: Tuberculosis should be suspected in patients with chronic torticollis and residing in an area when tuberculosis is endemic. Medical treatment is based on a quadruple antituberculosis chemotherapy with traction in the presence of atlanto-axial instability. Surgery is reserved in case of neurological worsening or persistent instability
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