Combined Posterior Stabilization and Anterior Endoscopic Transnasal Decompression for Atlantoaxial Tuberculosis Presenting With Quadriplegia in a Child: A Case Report and Literature Review

Tuberculosis of the craniovertebral junction (CVJ) is an uncommon condition, particularly in the pediatric population, and may present with severe neurological deficits due to instability and spinal cord compression. Surgical management is especially challenging because of the complex regional anatomy and the proximity of critical neurovascular structures. We report the case of a 14-year-old girl who presented with progressive quadriplegia and respiratory compromise secondary to atlantoaxial tuberculosis. Despite empirical antitubercular therapy, her neurological status continued to deteriorate. Imaging demonstrated extensive destruction of C1–2 with associated spinal cord compression and instability. A staged surgical approach was undertaken, consisting of posterior decompression and stabilization followed by anterior endoscopic transnasal decompression. Histopathological examination and GeneXpert testing confirmed tuberculosis, which was subsequently identified as multidrug-resistant disease. With appropriate antitubercular chemotherapy, the patient exhibited progressive neurological recovery and achieved complete functional recovery at follow-up. Early recognition of CVJ tuberculosis associated with neurological compromise and instability is essential. A multidisciplinary approach incorporating timely combined anterior and posterior surgical intervention, along with optimized antitubercular therapy, can result in excellent neurological and functional outcomes, even in severe presentations.