{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T22:47:26Z","timestamp":1776725246989,"version":"3.51.2"},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2002,9]]},"abstract":"<jats:p content-type=\"fine-print\"><jats:italic>Object.<\/jats:italic> The authors studied the immediate and long-term outcome after transoral decompression, occipitocervical fusion, and antituberculous therapy (ATT) in patients who had neurological deficits due to craniovertebral junction (CVJ) tuberculosis.<\/jats:p>\n<jats:p content-type=\"fine-print\"><jats:italic>Methods.<\/jats:italic> In this retrospective study, the authors reviewed the management and outcome in nine consecutive patients in whom features of spinal cord compression were observed and CVJ tuberculosis was diagnosed between 1993 and 1999. They ranged in age from 9 to 55 years. Onset of symptoms was acute or subacute and rapidly progressive (median 4 months, range 1\u201312 months). Patients presented with neck pain (89%), progressive limb weakness (89%), sensory symptoms (22%), and urinary dysfunction (33%). The mean preoperative functional grade based on the Nurick Scale was 3.4 (range 1\u20135). The disease caused reducible atlantoaxial dislocation (AAD) in three patients (33%), irreducible AAD in two (22%), basilar impression (BI) in one (11%), AAD with BI in one (11%), and C-2 vertebral body (VB) destruction without dislocation in two (22%). Surgery was performed in all cases. Five patients (56%) underwent transoral odontoidectomy, two (22%) transoral decompression of retropharyngeal abscess and granulation tissue, and two (22%) transoral decompression of abscess and diseased parts of the C-2 VB. All patients then underwent occipitocervical (occiput\u2014C3) fusion in which a contoured Steinmann pin and iliac bone grafts were used.<\/jats:p>\n<jats:p content-type=\"fine-print\">Postoperatively, ATT was prescribed for 18 months. In the immediate postoperative period, function in these patients improved from a mean Nurick grade of 3.4 to 2.3 (p &lt; 0.01). At long-term follow-up examination (median 18.8 months, range 7\u201346 months) function improved from a mean Nurick grade of 3.4 to 0.3 (range 0\u20132) (p &lt; 0.001).<\/jats:p>\n<jats:p content-type=\"fine-print\"><jats:italic>Conclusions.<\/jats:italic> Patients with CVJ tuberculosis with features of cervical myelopathy are ideally managed with transoral decompressive procedures followed by occipitocervical fusion because this therapy provides immediate neurological improvement, stability, and allows early mobilization. The long-term prognosis in patients with this disease is excellent provided it is treated with appropriate surgical intervention(s) and with adequate duration of ATT.<\/jats:p>","DOI":"10.3171\/spi.2002.97.2.0166","type":"journal-article","created":{"date-parts":[[2009,5,7]],"date-time":"2009-05-07T15:52:47Z","timestamp":1241711567000},"page":"166-171","source":"Crossref","is-referenced-by-count":11,"title":["Outcome in neurologically impaired patients with craniovertebral junction tuberculosis: results of combined anteroposterior surgery"],"prefix":"10.3171","volume":"97","author":[{"given":"Moses Joseph","family":"Arunkumar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vedantam","family":"Rajshekhar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Medicine (Baltimore)","first-page":"25","article-title":"Extrapulmonary tuberculosis revisited: a review of experience at Boston City and other hospitals.","volume":"6","author":"Alvarez","year":"1984"},{"key":"b2","series-title":"J Neurosurg (Spine 2)","doi-asserted-by":"publisher","first-page":"276","DOI":"10.3171\/spi.1999.90.2.0276","article-title":"Tuberculosis causing secondary basilar impression. Case illustration.","volume":"90","author":"Daniel","year":"1999"},{"key":"b3","series-title":"Br J Neurosurg","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1080\/02688690042852","article-title":"Management of tuberculomas of the craniovertebral junction.","volume":"14","author":"Edwards","year":"2000"},{"key":"b4","series-title":"J Bone Joint Surg (Br)","first-page":"47","article-title":"Tuberculosis of the upper cervical spine.","volume":"65","author":"Fang","year":"1983"},{"key":"b5","series-title":"J Bone Joint Surg (Am)","doi-asserted-by":"publisher","first-page":"1588","DOI":"10.2106\/00004623-196244080-00008","article-title":"Direct anterior approach to the upper cervical spine.","volume":"44","author":"Fang","year":"1962"},{"key":"b6","series-title":"Medicine (Baltimore)","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1097\/00005792-198305000-00005","article-title":"Tuberculous spondylitis. A report of six cases and review of the literature.","volume":"62","author":"Gorse","year":"1983"},{"key":"b7","series-title":"Clin Orthop","first-page":"118","article-title":"Occipitocervical arthrodesis. Indications, technic and results.","volume":"65","author":"Grantham","year":"1969"},{"key":"b8","series-title":"Clin Radiol","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1016\/S0009-9260(05)81162-6","article-title":"Computed tomography of vertebral tuberculosis: patterns of bone destruction.","volume":"47","author":"Jain","year":"1993"},{"key":"b9","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/S0090-3019(97)00294-2","article-title":"Craniovertebral junction tuberculosis: a rare but dangerous disease.","volume":"51","author":"Kanaan","year":"1999"},{"key":"b10","series-title":"Br J Neurosurg","doi-asserted-by":"publisher","first-page":"529","DOI":"10.3109\/02688699209002369","article-title":"Management strategies in tuberculous atlanto-axial dislocation.","volume":"6","author":"Lal","year":"1992"},{"key":"b11","series-title":"Can Assoc Radiol J","first-page":"199","article-title":"Tuberculosis of the odontoid bone: a rare but treatable cause of quadriplegia.","volume":"43","author":"Levin","year":"1992"},{"key":"b12","series-title":"J Bone Joint Surg (Br)","first-page":"183","article-title":"Atlanto-axial tuberculosis in adults.","volume":"68","author":"Lifeso","year":"1987"},{"key":"b13","series-title":"S Afr Med J","first-page":"553","article-title":"Tuberculosis of the cervical spine.","volume":"86","author":"Lukhele","year":"1996"},{"key":"b14","series-title":"Neurol India","first-page":"147","article-title":"John Hilton's contribution on atlanto-axial disease\u2014a forgotten chapter in the history of neurosurgery.","volume":"18","author":"Pandya","year":"1970"},{"key":"b15","series-title":"Neurol India","first-page":"116","article-title":"Tuberculous atlanto-axial dislocation (with remarks on the mechanism of dislocation).","volume":"19","author":"Pandya","year":"1971"},{"key":"b16","series-title":"South Med J","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1097\/00007611-199104000-00032","article-title":"Pott's disease of the cervical spine.","volume":"84","author":"Slater","year":"1991"},{"key":"b17","series-title":"Neuroradiology.","first-page":"859","author":"Taveras","year":"1992"},{"key":"b18","series-title":"Clin Orthop","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1097\/00003086-197410000-00023","article-title":"Tuberculosis of the craniovertebral region.","volume":"104","author":"Tuli","year":"1974"},{"key":"b19","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1007\/BF00298397","article-title":"Tuberculosis of the craniocervical junction: two case reports.","volume":"5","author":"Valaskatzis","year":"1996"},{"key":"b20","series-title":"Tuber Lung Dis","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1016\/S0962-8479(96)90037-4","article-title":"Pott's disease of the cervico-occipital junction in an AIDS patient.","volume":"77","author":"Ventura","year":"1996"},{"key":"b21","series-title":"Proc R Soc Med","first-page":"586","article-title":"Spontaneous hyperaemic dislocation of the atlas.","volume":"25","author":"Watson-Jones","year":"1932"},{"key":"b22","series-title":"Clin Infect Dis","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1093\/clind\/16.6.806","article-title":"Cervical tuberculous vertebral osteomyelitis: case report and discussion of the literature.","volume":"16","author":"Wurtz","year":"1993"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/97\/2\/article-p166.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/97\/2\/article-p166.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/97\/2\/article-p166.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T21:08:07Z","timestamp":1681592887000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/97\/2\/article-p166.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2002,9]]},"references-count":22,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/spi.2002.97.2.0166","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2002,9]]}}}