Tuberculosis of spine (C1 to D4)

Clinical data: Thirty-one patients with 33 lesions of spinal tuberculosis ( C1-D4) are reported. The distribution of lesions was C1-C2 (11), C3-C6 (13) , C7-D4 (9). Neurological complications were present in 6 (55%), 8 (61%) an d 7 (78%) in each region respectively, Diagnosis: Increase in the prevertebral soft tissue shadow in a standard ra diograph was a useful guide to resort to CT Scan/MRI to diagnose tuberculos is of C1 and C2 region at an early (pre-subluxation) stage. The diagnosis o f TB spine from C3-C6 was made confidently on clinico-radiological features . The anterior convexity and forward displacement of tracheal shadow of mor e than 8 mm from the vertebral bodies in a lateral view of plain X-ray and widening of superior mediastinum in an AP X-ray are useful indicators of tu berculous involvement at cervicodorsal region (C7-D4). CT Scan/MRI should b e done for early diagnosis in those cases with a high index of suspicion. Treatment and outcome: 12/33 lesions without neural complications healed wi th antitubercular drugs and the use of suitable orthosis, Out of 21 lesions with neural complications 14 recovered by local rest, skull traction and m ultidrug therapy. Seven lesions were surgically decompressed. Of these, fiv e recovered completely, two did not achieve useful recovery. The neural rec overy following the middle path regimen for tuberculosis of C1-D4 was 90% i n our cases.