From neck pain to neurological deficit: Cervical tuberculous spondylodiscitis unveiled: A case report

Cervical tuberculous spondylodiscitis is an uncommon but potentially devastating form of spinal tuberculosis. Its rarity, subtle clinical onset, and proximity to critical neurovascular structures make early diagnosis particularly challenging. Delayed recognition can lead to catastrophic outcomes, including spinal instability and neurological compromise. This case report aims to underscore the diagnostic pitfalls, highlight key imaging findings, and outline an effective management approach. A 36-year-old woman presented with a one-year history of progressive neck pain, followed by paresthesias in both upper limbs and the left lower limb. Examination revealed a suboccipital mass and sternocleidomastoid contracture. Imaging showed advanced destruction of the C1–C2 joint, with 12 mm diastasis, 80 % narrowing at the craniovertebral junction, and spinal cord compression. The patient underwent emergency posterior decompression and occipitocervical fusion. Histopathology confirmed tuberculosis through caseating granulomas and Langhans giant cells. The insidious onset and nonspecific symptoms of cervical spinal tuberculosis often delay diagnosis. MRI is essential for early detection of marrow edema, abscesses, and cord compression, while CT aids in assessing bone destruction. In this case, surgical intervention was required due to atlantoaxial instability and neurologic compromise. A multidisciplinary approach combining surgery and prolonged anti-tubercular therapy led to favorable outcomes. This case underscores the importance of early imaging, clinical vigilance, and timely surgical stabilization in preventing irreversible neurological damage. It contributes to the limited literature on upper cervical tuberculosis and highlights the value of individualized management strategies. • Cervical tuberculous spondylodiscitis is rare but carries a high risk of neurological complications. • Nonspecific early symptoms often delay diagnosis until advanced disease. • MRI is crucial for early detection; CT assists in surgical planning. • Histopathology confirms the diagnosis, supported by microbiological and molecular tests. • Management combines anti-tubercular therapy with timely surgery. • Clinical suspicion should be high in endemic areas and in patients with persistent neck pain and neurological signs. • This case underscores the need for early recognition to prevent irreversible deficits.