Spinal Tuberculosis Mimicking Failed Back Surgery

Abstract

Patient: Female, 59Final Diagnosis: Spinal tuberculosisSymptoms: Back pain • tiredness • night sweatsMedication: —Clinical Procedure: Surgery and medical treatmentSpecialty: NeurosurgeryObjective:Challenging differential diagnosisBackground:The aim of this study was to draw attention to rare spinal infections in recurrent failed spinal surgeries.Case Report:A 59-year-old female was admitted to the hospital for back pain, which was assessed as a 9 on the visual analogue scale (VAS); the patient reported tiredness and night sweats. She had an operation for L3–4 far lateral disc herniation four years ago. Then another operation for L4–5 disc herniation six months ago and immediately three months later she has an operation with L3–4–5 fixation again. She had hypothyroidism, diabetes mellitus, and hypertension. Her daughter was cured of pulmonary tuberculosis 20 years ago. We performed an operation by L4–5 discectomy; all granulation formation with inflammatory processes were debrided and irrigated with antibiotics at levels of L3–5. The old fixation was controlled and replaced. Her back pain improved immediately after surgery; she had a score of 2 on the VAS. Two days after her surgery, our Infection Disease Department reported acid resistant bacillus (ARB+) in samples and began anti-tuberculosis medication.Conclusions:Spinal infections should always be taken into consideration in recurrent failed back surgeries.

Apparent Provisional Diagnosis Validated by Histopathology: 2 Case Report that mimics TB Spine Conflict of interest: There is no Conflict of interest relevant to this paper to disclose

“…In tubercular spondylodiscitis, there is the presence of a large adjacent soft tissue component, rim-enhancing abscesses, and bone fragments which usually compress neural elements 10 . These clinic -radiological features are not typical for tubercular spondylodiscitis, rather in various reported articles, these features are consistent with other lesions mimicking Pott's disease [11][12][13][14][15] .…”

Transverse process strut and titanium mesh cages in the stability reconstruction of thoracic single segment tuberculosis: a retrospective single-center cohort study

“…The transverse process, as an autogenous bone, can be trimmed to the specifications of the bone defect,which not only reduces the difficulty of implantation but also ensures the strength of bone grafting and creates a large interface between the bone graft and the end plate, assuring good fusion. Compared with TMCs [23][24][25][26][27][28], TPS has superior biomechanical features and multiple transverse bone grafts can be used if the defect requires them. In our study, we used TPS combined with internal fixation; all patients showed satisfactory fusion, and the postoperative kyphosis angle was significantly corrected, indicating that TPS can effectively support the spine.…”