Thursday, 29 September 2011

Cervical Pott’s and retropharyngeal abscess

A 50 yo male with compressive myelopathy. Severe neck pain.
MRI Cervical Spine
Sagittal T2 and T1 images show altered marrow signals involving C2 and C3 vertebral bodies with diffuse marrow odema on STIR. Intervening C2-3 disc is destroyed with endplate erosions. An associated prevertebral abscess (green astricks). The adjacent anterior epidural abscess (yellow astricks) causing significant cord compression.

Imagingwise : Cervical vertebral Osteomyelitis with an associated epidural and prevertebral abscess.

Discussion:
Retropharyngeal or pre vertebral abscess in adult is usually develop secondary to direct invasion of pyogenic bacteria after direct trauma to pharynx followed by secondary involvement of adjacent cervical spine.
However there may be a pre exiting cervical osteo myelitis with an associated prevertebral abscess, tuberculosis as a cause is not an unusual in endemic areas like india.

The incidence of tuberculosis is increasing in parallel with the growing numbers of immunocompromised patients.
Presentation is variable either with cord compression due to pathological fracture, an associated epidural abscess or with respiratory distress due to an associated prevertebral abscess. Awareness of this may lead to early diagnosis and treatment.

Tuberculosis or Pott’s disease of spine has predilection for dorsal region followed by lumbar. Cervical region is uncommon.
CV junction contributes ~ 0.3 to 1% of total tubercular spondylitis.

It is important to understand the fact that anti tubercular therapy is the crucial factor in treatment of this condition and not the surgery.  But when neurologic deficits are present due to cord compression, debridement and anterior spinal fusion combined with antituberculous chemotherapy is ideal.

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