A 6-year-old boy has persistent neck pain, torticollis, and refuses to hold his head upright for 3 weeks, with occasional night cries. He is afebrile. Lateral radiographs show rarefaction of the odontoid process with soft tissue widening in front of the cervical spine. What is the most appropriate immediate management priority?

• A Skull or halter traction immobilisation along with antitubercular therapy ✓
• B Immediate posterior C1-C2 fusion
• C Physiotherapy with active range of motion exercises
• D Fine needle aspiration cytology of the retropharyngeal mass as the sole intervention

Explanation

Atlantoaxial tuberculosis threatens the cord because instability at C1-C2 can cause sudden respiratory arrest and death, so the first priority is rigid immobilisation by traction, followed by antitubercular chemotherapy. Surgery is reserved for patients who fail conservative care or have significant neurological deficit, so primary fusion is premature. Encouraging movement risks catastrophic subluxation. Aspiration may aid diagnosis but does nothing to protect against the life-threatening instability.

Reference: Tuli's Tuberculosis of the Skeletal System, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.