Journal List > J Korean Soc Spine Surg > v.22(3) > 1076058

J Korean Soc Spine Surg. 2015 Sep;22(3):127-132. Korean.
Published online September 30, 2015.  https://doi.org/10.4184/jkss.2015.22.3.127
© Copyright 2015 Korean Society of Spine Surgery
Atypical Tuberculous Spondylitis: A Report of Two Cases
Hak Jin Min, M.D., Hyung Gon Ryu, M.D. and Seong Kee Shin, M.D.
Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, Republic of Korea.

Corresponding author: Seong Kee Shin, M.D. Department of Orthopedic Surgery, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul, Korea TEL: +82-2-2276-8525, FAX: +82-2-539-1262, Email: 1435man@hanmail.net
Received May 15, 2015; Revised July 01, 2015; Accepted September 03, 2015.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Study Design

Case study of two cases.

Objectives

The aim of our study is to describe atypical patterns of tuberculous spondylitis.

Summary of Literature Review

Few reports of tuberculous spondylitis have discussed atypical cases, which resulted in a poor prognosis due to the delay in early diagnosis and proper treatment.

Materials and Methods

A 74-year-old female underwent an incision and drainage, and posterior decompression and fusion (PDF) due to tuberculous epidural abscess after vertebroplasty of a compression fracture at T12. A 52-year-old female underwent interbody fusion and posterior lateral fusion (PLF) because of aggravation of an abscess and neurologic symptoms following non-invasive intervention to treat atypical tuberculous spondylitis.

Results

Clinical symptoms and serological tests of the patients were improved at postoperative 6 months.

Conclusions

When a patient presents with focal bony or soft tissue abnormality on an image study, the possibility of non-typical tuberculous spondylitis has to be considered when infective spondylitis or a tumor is detected. Moreover, an invasive diagnosis tool such as biopsy will be needed for proper management.

Keywords: Tuberculous spondylitis; Atypical; Biopsy

Figures


Fig. 1
(A) T1-weighted sagittal image shows low signal intensity in the T12 vertebral body found by usual acute compression fracture. Lateral radiographs show the site after vertebroplasty T12 and kyphotic deformity. (B) MR images show T11 superior end plate destruction and epidural abscess at the T10-12 level after 8 weeks of vertebroplasty. (C) MR images show a small amount of epidural abscess at postoperative 6 months. (D) The histologic findings show caseous necrosis with chronic granulated inflammation (H-E staining, 200× magnification).
Click for larger image


Fig. 2
(A) The evidence of brain magnetic resonance (MR) images that show tiny disseminated enhancing nodules with mild edema in the whole brain results in brain infection from Tb spondylitis. (B) Brain MR images show that the previously disseminated small enhancing nodules have nearly completed disappeared at postoperative 4 months.
Click for larger image


Fig. 3
(A) Preoperative magnetic resonance (MR) images show the signal change of bone in an epidural abscess and infective spondylitis at the L5-S1 level. (B) MR images show progression of infective spondylitis as well as a larger abscess than in previous study 8 weeksafter discectomy and laminotomy. (C) AP and lateral radiographs taken at the 6-month follow-up after interbody fusion show solid bony fusion.
Click for larger image

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