Lateral atlantoaxial facetal dislocation in craniovertebral region tuberculosis: report of a case and analysis of an alternative treatment.

PURPOSE: A case of tuberculosis is reported in which there was extensive unilateral destruction of the bones of the craniovertebral junction. A lateral facetal subluxation of the relatively well-preserved contralateral atlantoaxial joint was identified. The patient was treated with unilateral fixation of the subluxated joint using a lateral mass plate and screw method of fixation. The pathogenesis of facetal subluxation and the rationale of the treatment adopted are discussed. CASE REPORT: A 63-year-old male patient had systemic tuberculosis and had been on drug treatment for 5 months. For about 1 month, he had experienced severe neck pain and progressive quadriparesis. Investigations revealed extensive unilateral destruction of the lateral masses of atlas and axis and occipital condyle. MRI showed altered cord signal at the level of the craniovertebral junction. CT scan showed contralateral lateral subluxation of the facet of atlas over the facet of axis. Unilateral fixation and distraction of the lateral mass of atlas and axis, external orthosis and antituberculous drug treatment resulted in rapid and sustained neurological recovery.
CONCLUSION: Contralateral atlantoaxial facetal subluxation can be a result of osteoligamentous incompetence in cases of tuberculosis where there is unilateral facetal destruction. A coronal CT scan view can be diagnostic in such cases. Atlantoaxial lateral mass fixation can be a rational form of surgical treatment in such cases.