Findings reveal destruction
of anterior arch of C1 with pre vertebral abscess: Koch's Spine.
Although incidence of tuberculosis of spine in cases of skeletal tuberculosis
is quite high, it is a rare occurrence in cervical spine, i.e. 3%-9.4%
out of all cases of spinal tuberculosis. Involvement of lower cervical
spine is a rarity especially below the level of C4(5). The disease can
occur at any age but it is supposed to be a disease of childhood, the
maximum occurrence being in the first decade of life. Common presenting
features are back pain, deformity and paraplegia: pain being the commonest
in about 75% of the cases.
The number of the vertebrae involved varies from single vertebra to 14
vertebral segments, average being 3.8 vertebral segments. Children seem
to have a more severe type of disease than the adults and involvement
of more than two vertebrae is frequent in children. In majority of the
cases, patients are seen when disease is already well advanced with destruction,
collapse and abscess formation. The incidence of abscess formation detected
clinically or radiologically is dependent upon the site of disease, lowest
being in the cervical region.
Ashok Raghavan, Manipal Hospital, Bangalore