AB1047 Cervical pott’s disease: 5 case reports and review of literature
Authors: A. Romdhane, N. Karmani, J. Kallel, I. Ben Said
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Spinal tuberculosis (Pott's disease) is the most common as well as one of the most dangerous forms of skeletal tuberculosis and accounts for 50% of all cases of skeletal tuberculosis. Pott's disease is still common in developing countries. Although the thoracolumbar junction seems to be the most common site of the spinal column involvement, cervical localization is scarce and accounts for 2% to 5% of spinal tuberculosis. Furthermore, the incidence of neurologic complications in spinal tuberculosis varies from 10% to 43%. <h3>Objectives</h3> The purpose of this study was to perform an updated review and present our experience with 5 cases of tuberculosis of cervical spine, including clinical characteristics, diagnostic modalities and management of spinal tuberculosis. <h3>Methods</h3> A review of 5 cases of cervical Pott's disease collected at the Department of Neurosurgery of National Institute of Neurology of Tunis over a period of 2 years, between 2011 and 2012 and an updated literature review. <h3>Results</h3> The average age of our patients was 35 years old with extremes ranging from 16 to 63 years old. There is a slight male predominance. The diagnostic delay is on average 6 months. The clinical manifestations were dominated by cervical pain (4 cases) and progressive spinal cord compression syndrome (3 cases). The biological inflammatory syndrome is found in only one patient. The intra-dermal reaction to tuberculin is positive in 4 patients. X-ray of the cervical spine, CT scan and magnetic resonance imaging were performed in all patients. All patients underwent a surgical resection. The medical treatment was administered to all our patients. The evolution was favourable, clinically and biologically, under anti tubercular treatment. Tuberculous spondylodiscitis remains a major global public health problem in endemic countries that affects mostly young adults in their most productive years. Thoracolumbar junction seems to be the most common site of the spinal column involvement in spinal tuberculosis (95%) and cervical spine is concerned in only 5% of cases. The delayed diagnosis, between 3 and 20 months, explains the frequency of neurological deficits which are found in proportions of 20% to 40%. For the diagnosis of spinal tuberculosis, magnetic resonance imaging is more sensitive imaging technique than x-ray and more specific than computed tomography. Antituberculous treatment remains the cornerstone of treatment. Surgery may be required in selected cases. With early diagnosis and early treatment, prognosis is generally good. <h3>Conclusions</h3> Cervical Pott's disease is a rare localization. The diagnosis is easy in front of the cervical signs. The conservative management of cervical spine immobilisation and antitubercular chemotherapy remains a sufficient attitude to healing. Surgery is reserved in case of neurological aggravation or spinal instability. <h3>References</h3> [1] Jain AK. Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg Br2010;92(7):905–13. [2] Jain AK, Dhammi IK. Tuberculosis of the spine: a review. Clin Orthop Relat Res2007;460(July):39–49. [3] Boachie-Adjei O, Squillante RG. Tuberculosis of the spine. Orthop Clin North Am1996;27(1):95–103. [4] Dharmalingam M. Tuberculosis of the spine. the Sabah experience. Epidemiology, treatment and results. Tuberculosis (Edinb)2004;84(1–2):24–8. <h3>Disclosure of Interest</h3> None declared