Dr Nandan Marathe Spine Fellow Toronto Western Hospital Prof Sudhir Srivastava Seth GS Medical College and KEM Hospital Presenter Nandan Marathe TB in Atlantoaxial segment Unique Critical Junctional area ID: 914941
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Is atlantoaxial TB different? Its altered biomechanics and treatment strategies
Dr. Nandan Marathe: Spine Fellow, Toronto Western HospitalProf. Sudhir Srivastava: Seth GS Medical College and KEM Hospital
Slide2Presenter: Nandan
Marathe
Slide3T.B in Atlanto-axial segment - Unique
Critical Junctional area
Inherently prone for instabilityUnique pathoanatomy
Tumbling of the heavy skull
“Hat on Hook” in spine
Slide4Slide5Grade
I
(Early involvement)
Grade
II
(Moderate involvement)
Grade
III
(Significant involvement)
AKT, collar , traction
AKT, collar , traction
AKT, collar , traction
Improved (stable)
Unstable
Stable
Unstable
Concentric collapse
Unstable
Continued conservative management
Operative intervention
Occipito-cervical fixation and fusion
Transarticular screw fixation and fusion
Slide6Slide7Slide8Results
All 108 patients underwent a minimum follow-up of 18 months
Mean follow-up: 50.23±24.46 months (range, 18–153 months)64 males and 44 females
5 patients: lesions at multiple sites
6 cases of MDR TB
Age of patients: 4 to 60 years
40 patients being less than 18 years of age.
Slide9Results
CONSERVATIVE GROUP
Clinically appreciable tilt = 6
Axial settling = 10
No functional disability
SURGICAL GROUP
No neurological deterioration
All 8 patients of clinical grade III - 7 ambulatory
2 patients loss of correction (occipito cervical group)
Slide10Conclusion
Early detection/ prevention of complications: always a desirable goal
Neurological recovery is usually achieved by canal re-alignment and neural decompression
Assessment of reducibility, extent of bony destruction and meticulous planning
Sound and long lasting result in CVJ tuberculosis