Spontaneous Atlantoaxial Subluxation due to Pyogenic or Tuberculosis Vertebral Osteomyelitis: Diagnosis and Treatment

ABSTRACT

OBJECTIVE: The purpose of this study is to evaluate the clinical and radiographic results of infective atlantoaxial subluxation, and to describe the management of pyogenic or tuberculosis atlantoaxial subluxation. METHODS: In this study, we present seven patients with atlantoaxial subluxation after pyogenic or tuberculosis vertebral osteomyelitis. Prominent manifestations included neck pain and stiffness, swelling of the retropharyngeal soft tissues, quadriparesis, and osteolytic erosions. All patients received antibiotics/antituberculosis medication. One patient was managed conservatively, two underwent only transoral biopsy, one patient underwent transoral decompression and posterior fusion, and three patients underwent only posterior fusion. RESULTS: All patients showed significant improvement in neck pain and neck movement. Three patients who showed quadriparesis or motor weakness at the time of diagnosis showed improvement in motor strength, although subjective weakness persisted in two patients. CONCLUSION: In our study, we describe the management of this disease at our institute. Available treatment modalities vary from purely conservative medical management to surgical correction. Medical treatment is the mainstay of management. The need for and the extent of surgery are dependent on the presence of instability and spinal cord compression and should be determined on a case by case basis.