Atlantoaxial tuberculosis: three cases

Tuberculosis of the craniocervical junction (CCJ) is exceedingly rare but c arries a risk of compression of the medulla oblongata and upper spinal cord . Three cases among 63 patients with spinal tuberculosis are reported. Mean age was 51 years (range, 20-69) and mean time to diagnosis was 4.6 months (range, 1-8). Although atlantoaxial dislocation was a consistent feature, n one of the patients had neurological deficits. Computed tomography of the C CJ disclosed a suggestive pattern combining osteolysis and an abscess anter ior to the spine. The diagnosis was confirmed by microbiological studies in two cases and histology in one. The outcome was favorable after antituberc ulous therapy, immobilization of the neck, and surgical fusion. Although tu berculosis remains common in developing countries, involvement of the CCJ i s rare. Tuberculosis of the CCJ carries a risk of instability and severe ne uraxis compression. Consequently, early diagnosis and treatment are of the utmost importance. (C) 2000 Editions scientifiques et medicales Elsevier SA S.