Reema Chaudhary MBBS, Presenter: Nothing to Disclose

Prabodhan Potdar, Abstract Co-Author: Nothing to Disclose

Kshitij Chaudhary, Abstract Co-Author: Nothing to Disclose

Vinod Laheri, Abstract Co-Author: Nothing to Disclose

A study of patients in different stages can help put together a chain of events which reveals a sequence of tuberculous destruction at CVJ. This has never been described before. Objectives is to: Elucidate pathogenesis of CVJ TB and correlate symptoms with radiology

Retrospective review of records of 52 cases of CVJ TB. Patients presented with neck pain (52), torticollis (13), hypoglossal nerve palsy (2), myelopathy (19), respiratory distress (3), dysphagia (3). Dynamic radiographs, CT and MRI were performed. Infection was looked for in occipital bone, atlas, axis, C3 and C4. Lesions were classified as- Type 2: breakdown of structural integrity of area, Type 1: Areas with erosions or signal change but with preservation of structure. Abscess was classified as retropharyngeal, prevertebral, preclival, paravertebral, peridental, epidural. Instability was classified as anterior-posterior (AP), rotatory and vertical instability. Stages were defined as: Stage 1 (18)- No bone destruction, no instability, Stage 2 (15) - AP instability due to ligament disruption, without significant bone destruction, Stage 3 (19) - AP or vertical Instability due to severe bone destruction.

Type 1 and Type 2 lesions were 254 (32%) and 67 (8.6%) respectively. Lesions were most commonly seen in dens (92%) followed by C1 lateral mass (77%), C2 superior facets (59%). Abscess formation was seen in 47 (90%) and no abscess was found in retropharyngeal space. Cause of torticollis were muscle spasm, rotatory subluxation or collapse of C1 lateral mass. Two patients with destroyed occipital condyles had hypoglossal nerve palsy. Large prevertebral abscess caused dysphagia. Myelopathy was seen in 0, 8(53%), 11(57%) patients in Stage 1,2 and 3 respectively.

The infection starts in synovial joints of CVJ and areas around the joints (dens and C1 lateral mass) are most commonly affected. The cause of neurological deficit is instability rather than epidural granulation tissue. Ligament destruction precedes bone destruction. Destruction of lateral weight bearing column of CVJ results in vertical instability.

The study describes the pathogenesis of tuberculous destruction at craniovertebral junction and correlates clinical findings with radiological presentation.

Chaudhary, R, Potdar, P, Chaudhary, K, Laheri, V, Pathogenesis and Staging of Craniovertebral Tuberculosis: An Imaging Study of 52 Cases.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11014336.html