Posterior listhesis of a lumbar vertebra in spinal tuberculosis

[摘要] OpenimageinnewwindowThemanagementofspinaltuberculosis,especiallyinchildren,iscontroversial.Inchildren,vertebraldestructionismoreseverethanadultsbecauseofthecartilaginousnatureoftheirbone.Modernchemotherapyhassignificantlydecreasedmortalityinspinaltuberculosis,butmorbidityremainshigh.Withoutearlysurgery,patientscandevelopseverekyphosisleadingtorespiratoryinsufficiency,painfulcostopelvicimpingementandparaplegia.Lumbarkyphosisresultsinearlydegenerativelumbarcanalstenosisandiscosmeticallyunacceptable.Wereportapaediatriccaseofatypicalspinaltuberculosisdemonstratingtheneedforearlysurgicalinterventiontopreventsignificantspinalinstabilityandneurologicdeficit.A12-year-oldgirlpresentedwithincreasingambulatorydifficultyanddoubleincontinence4 monthsafterinitiatingtreatmentforpulmonarytuberculosis.Therewasnohistoryoftraumaticinjury.Examinationrevealedseverelowerlimbneurologicdeficit,withhypotonia,areflexia,markedsensoryloss,andgrade0/5powerinbothlowerlimbs.Plainradiographsandmagneticresonanceimaging(MRI)demonstratedgradeIVposteriorlisthesisoftheL2vertebralbodyoverL3,caudaequinacompressionandbilateralpsoasabscesses.ErosionofboththebodyandpedicleofL2wasobserved.Bothserologyandpusdrainedfromthepsoasabscesseswerenegativeformicroorganisms.ThepatientunderwentanL2vertebrectomyviaaleftretroperitonealapproach.Atitaniumcagepackedwithautologousbonegraftwasinserted,andthespinewasstabilizedbyfixationwithscrewandrods.Histopathologyconfirmedadiagnosisoftuberculosis.Eighteenmonthsfollowingtheprocedure,thepatienthasregainedsomepowerinherrightlegandhascompletedhercourseofanti-tuberculouschemotherapy,butremainswheelchair-bound.Toourknowledge,thisisthefirstreportedcaseofposteriorlisthesissecondarytospinaltuberculosis.Here,wediscussthepossiblemanagementoptionsinsuchacase,andtheindicationsforsurgery.AstheglobalHIV/AIDSepidemiccausesaresurgenceintuberculosis,increasedawarenessamongthemedicalcommunityregardingtheatypicalpresentationsofspinaltuberculosisisnecessitated;bothinthedevelopingworldwhereadvancedclinicalpresentationsarecommon,andinthedevelopedworldwherespinaltuberculosisisanoften-neglecteddiagnosis...

[学科分类] 骨科学

[关键词] Posterior listhesis ;Spinal tuberculosis ;Lumbar spine ;Vertebrae ;Pott’s disease