Wensen Pi, Yang Liu, Haidan Chen, Hongwei Zhao

Department of Spine Surgery of Yichang Central People’s Hospital, First Clinical Medical College of China Three Gorges University, Yichang, Hubei, 443000, People’s Republic of China

Correspondence: Hongwei Zhao; Haidan Chen, Department of Spine Surgery of Yichang Central People’s Hospital, First Clinical Medical College of China Three Gorges University, Yichang, Hubei, 443000, People’s Republic of China, Email ycguke@sina.com; wenquanchd@sina.com

Abstract: Tuberculous spondylitis following percutaneous vertebroplasty or kyphoplasty is rare. In this, we report a rare case of tuberculous spondylitis diagnosed after percutaneous vertebroplasty (PVP). A 69-year-old female sought came to our department with a history of chest and back pain from the last two months accompanied by weakness in both lower limbs. The patient underwent two vertebroplasty procedures at a local hospital within two years for compression fractures of the lumbar and thoracic spine. Due to continuous lower back pain following PVP surgery, along with the worsening back pain weakness in both lower limbs over the past 2 months, the patient presented to our hospital for the treatment. Radiological imaging showed long bone destruction in the L1, L2, and T12 vertebrae, accompanied by the formation of numerous paraspinal abscesses. The serum T-SPOT test yielded a positive result. A sample was taken from a paravertebral abscess for TB DNA testing (GeneXpert MTB/RIF assay) under the guidance of CT, which demonstrated the patient was infected with a non-drug-resistant strain of TB. The patient underwent surgical treatment via a combined anterior and posterior approach. The histological examination of the excised tissue revealed evidence of tuberculosis, characterized by granulomatous inflammation and sheet necrosis. After taking anti tuberculosis drugs for 12 months, the patient recovered without any sequelae. Spinal tuberculosis and osteoporotic vertebral compression fractures are similar in clinical and radiological aspects. Spinal surgeons should consider the entity of this disease to avoid misdiagnosis or complications. After diagnosis of spinal tuberculosis after vertebral augmentation surgery, early surgical intervention and anti-tuberculosis treatment should be carried out immediately.

Keywords: Tuberculous spondylitis, vertebroplasty