Conservative management for pediatric craniocervical Pott’s disease: A case study and literature review

• Published in: Child's nervous system Vol. 40; no. 6; pp. 1867 - 1871
• Main Authors: Parent, Anne-Sophie, Tu, Albert
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2024
• Subjects: Adolescent; Antitubercular Agents - therapeutic use; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - surgery; Conservative Treatment - methods; Humans; Male; Medicine; Medicine & Public Health; Mini Review; Neurosciences; Neurosurgery; Tuberculosis, Spinal - diagnostic imaging; Tuberculosis, Spinal - surgery; Tuberculosis, Spinal - therapy; Spinal tuberculosis; Craniovertebral junction; Pott's disease; Atlanto axial dislocation
• ISSN: 0256-7040; 1433-0350
• DOI: 10.1007/s00381-024-06338-3

Craniocervical Pott’s disease is rare, particularly in the pediatric population. The importance of motion preservation in this age group renders managing this disease even more challenging. The literature regarding craniocervical Pott’s disease comes from endemic regions. Most authors will agree on early surgical intervention in cases of neurological compromise or severe instability, while patients with minimal symptoms will do well with conservative management. Controversy remains when patients are mildly symptomatic but with imaging findings concerning for significant instability. Here, we present the case of a 15-year-old male presenting with craniocervical tuberculoma with radiographic instability and advanced bony destruction without overt neurological deficits. He was managed with a rigid cervical collar and completed 1 year of anti-tuberculosis therapy. At 1-year follow-up, he had an intact range of motion, was pain-free, and remained neurologically intact. Although this case suggests good outcomes with conservative management are possible, more long-term follow-up is required to assess the need for delayed surgical intervention in this unique population.