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%) and 7 (78%) in each region respectively. DIAGNOSIS: Increase in the prevertebral soft tissue shadow in a standard radiograph was a useful guide to resort to CT Scan/MRI to diagnose tuberculosis of C1 and C2 region at an early (pre-subluxation) stage. The diagnosis of TB spine from C3-C6 was made confidently on clinico-radiological features. The anterior convexity and forward displacement of tracheal shadow of more 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 tuberculous involvement at cervicodorsal region (C7-D4). CT Scan/MRI should be done for early diagnosis in those cases with a high index of suspicion. TREATMENT AND OUTCOME: 12/33 lesions without neural complications healed with antitubercular drugs and the use of suitable orthosis. Out of 21 lesions with neural complications 14 recovered by local rest, skull traction and multidrug therapy. Seven lesions were surgically decompressed. Of these, five recovered completely, two did not achieve useful recovery. The neural recovery following the middle path regimen for tuberculosis of C1-D4 was 90% in our cases.