Application of the modified lifeso radiographic staging system to the management and outcomes for craniocervical tuberculosis.

Objective: To describe a management algorithm for cervicovertebral junction (CVJ) TB based upon disease severity and neurological status at presentation.

Methods: Retrospective cohort study of 52 patients treated for microbiologically or clinically-diagnosed CVJ TB at a tertiary referral center in a TB endemic area were identified. Data were gathered about presenting symptoms, baseline neurological status, management strategy, and management outcomes. Patients were categorized by a modified Lifeso Stage.

Results: Fifty-two patients were included (Mean age 28.5 ± 13.4 yr, 48% male): 18 Lifeso Stage I, 15 Stage II, and 19 Stage III. All presented with pain, 19 (37%) with neurological symptoms, and 5 with inability to ambulate. Stage II and III patients were more commonly myelopathic at presentation (p < 0.01) than Stage I patients. Only Stage II/III lesions required traction or surgical intervention; Stage III lesions more commonly required surgery than Stage II lesions (100% vs. 73%; p = 0.03). Among surgically-treated Stage II and III lesions, Stage III lesions had longer symptom prodromes (5.1 ± 2.2 vs. 3.3 ± 1.4mo; p = 0.03), more commonly had lateral mass collapse at presentation (58 vs. 9%; p = 0.02), and more commonly required occipitocervical fusion (68 vs. 9%; p < 0.01).

Conclusion: Based upon these data, Stage I lesions may be treated conservatively, unless presenting with a neurological deficit. Conversely, Stage III lesions require open reduction and instrumentation due to irrevocable underlying bony damage. Reducible Stage II lesions with absent or mild neurological symptoms can be treated conservatively, but irreducible lesions and those with concomitant neurological deficits merit surgery.