Case 32 :
A young female presents with history of seizures and mental retardation.

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Fig 1.
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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.

Dr Ashok Raghavan, Manipal Hospital, Bangalore