Treatment of atlantoaxial tuberculosis with neurological impairment: A systematic review

Abstract Background Tuberculosis (TB) in the atlantoaxial joint is a rare disease. However, the treatment of atlantoaxial TB with neurological impairment is controversial. The aim of this review is to provide clinical outcomes of surgical and non-surgical management of atlantoaxial TB. Methods Databases, including PubMed, Embase and the Cochrane Central Register of Controlled Trials, were searched for English literature describing the treatment of atlantoaxial TB with neurological deficits. The outcomes of conservative and surgical treatment approaches, including treatment failure, death, changes in neurological impairment and complications, were compared by performing odds ratio (OR) analysis. Results Overall, 24 studies (247 patients) meeting the inclusion criteria were analysed. There were 94 (38%) patients treated conservatively and 153 (62%) patients treated surgically. The rate of poor outcomes was greater in the conservative group (14.89%) than in the surgery group (1.3%) [OR, 0.081; 95% confidence interval (CI), 0.016–0.39]. There was no significant difference in mortality between the conservative (1.06%) and surgery (3.27%) groups (OR, 3.28; 95% CI, 0.494–27.381). There was no significant difference in muscle power improvement between the two treatments (conservative: 95.7%; surgery: 94.8%; OR, 1.353; 95% CI, 0.291–4.925). Conclusion Conservative and surgical treatments both significantly improved neurological deficits in most of the patients. In comparison with conservative treatment, surgical treatment reduced treatment failures without significantly increasing the rates of neurological deficit improvement or mortality.