Cervical Spine Tuberculosis and Retropharyngeal Space Involvement
Yes, cervical spine tuberculosis commonly spreads to the retropharyngeal space, and this is a well-documented and clinically significant complication that requires prompt recognition and treatment.
Mechanism and Frequency of Spread
Cervical spine tuberculosis (Pott's disease) characteristically extends into the retropharyngeal space through direct spread from infected vertebral bodies and intervertebral discs. 1, 2
The retropharyngeal abscess formation is typically secondary to tuberculosis of the cervical spine, particularly when the upper cervical vertebrae are involved. 1, 3, 4
This pattern of spread occurs because the anatomical proximity of the prevertebral space to the retropharyngeal space allows tuberculous infection to track anteriorly from the spine. 2, 5
Clinical Presentation
When cervical spine TB spreads to the retropharyngeal space, patients typically present with:
Neck pain and stiffness combined with dysphagia and odynophagia (painful swallowing). 1, 4
Anterior displacement of the posterior pharyngeal wall visible on oral cavity examination. 4
Hoarseness of voice due to mass effect on surrounding structures. 1
Swelling of the retropharyngeal soft tissue evident on imaging. 5
The onset is characteristically insidious, which can delay diagnosis. 1, 2
Dangerous Complications
Cervicomedullary compression can occur from the combination of vertebral destruction, instability, and retropharyngeal abscess formation, potentially leading to severe neurological complications or death. 2
Involvement of the craniocervical junction (occipital condyles and foramen magnum) represents a particularly dangerous manifestation. 2
Atlanto-axial subluxation may develop, especially with upper cervical spine involvement. 5
Diagnostic Approach
MRI of the cervical spine with and without IV contrast is essential to evaluate both the vertebral involvement and the extent of retropharyngeal abscess formation. 6
CT imaging can demonstrate osteolytic erosions of the vertebral bodies and characterize the soft tissue mass. 4, 5
Lateral neck radiographs will show increased prevertebral soft tissue thickness. 5
Treatment Strategy
Conservative management with anti-tuberculosis drugs is the primary treatment and can result in good outcomes when initiated early. 1, 3
Transoral biopsy, aspiration, and debridement of the retropharyngeal abscess should be performed for tissue diagnosis and to relieve mass effect. 2, 4
External stabilization (halo jacket or cervical collar) may be necessary for vertebral instability. 3, 5
Surgical intervention with C1-2 fusion is indicated for patients with severe neurological complications, persistent instability, or failure of medical management. 2, 5
Critical Clinical Pitfalls
Do not dismiss insidious neck symptoms in immunocompromised patients or those from TB-endemic areas, as the early clinical picture can be nonspecific. 2
The diagnosis may be obscured by concurrent psychiatric illness or other medical conditions. 2
AIDS patients are at particular risk for cervico-occipital Pott's disease with retropharyngeal involvement. 3
Delayed diagnosis increases the risk of irreversible neurological damage and mortality. 2