J Korean Soc Spine Surg.  2015 Sep;22(3):127-132. 10.4184/jkss.2015.22.3.127.

Atypical Tuberculous Spondylitis: A Report of Two Cases

• Min HJ
• Ryu HG
• Shin SK

• KMID: 2068933
• DOI: http://doi.org/10.4184/jkss.2015.22.3.127

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.

Keyword

Tuberculous spondylitis; Atypical; Biopsy

MeSH Terms

Abscess
Aged
Biopsy
Decompression
Diagnosis
Drainage
Early Diagnosis
Epidural Abscess
Female
Fractures, Compression
Humans
Middle Aged
Neurologic Manifestations
Prognosis
Serologic Tests
Spondylitis*
Vertebroplasty

Figure

• 

  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).

• 

  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.

• 

  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 followup after interbody fusion show solid bony fusion.

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