Stabilizing the unstable: Tuberculosis of the odontoid process with atlanto-occipital instability-Case report and review of literature

Key Clinical MessageTuberculosis (TB) of the odontoid process is a rare but potentially, a debilitating condition. Surgical intervention, in the form of stabilizing the spine and decompressing the spinal cord, offers a tailored approach to managing this condition effectively and improving prognosis.AbstractOdontoid process tuberculosis (TB) is a rare condition that can cause spinal instability and neurological complications. Diagnosis of odontoid process TB is difficult and requires a combination of clinical, radiographic, and histopathological examinations. This report describes the treatment of a 46-year-old female with quadriparesis and intermittent fever. Radiological findings showed TB of the odontoid process with atlanto-axial dislocation causing compressive myelopathy. She underwent C1-C3 decompressive laminectomy and stabilization from C1 to C5. GeneXpert for TB was positive and she was started on anti-tuberculous medications. She regained power gradually and at 1 year follow-up she was ambulant without any support. The C1-C5 lateral mass screw and C1-C3 decompressive laminectomy approach, as highlighted in this case, offers an effective solution, enhancing patient quality of life, and preventing disease progression. Sagittal MRI demonstrating destructive lesion in the odontoid process with pannus formation and compression. 1B: Axial MRI demonstrating the destruction of the anterior elements of C2 with pannus and involvement of the ligamentous complex.image