Clin Orthop Surg.  2009 Mar;1(1):58-62. 10.4055/cios.2009.1.1.58.

A Case of Postoperative Tuberculous Spondylitis with a Bizarre Course

• Jeon DW
• Chang BS
• Jeung UO
• Lee SJ
• Lee CK
• Kim MS
• Nam WD

• KMID: 1127916
• DOI: http://doi.org/10.4055/cios.2009.1.1.58

Abstract

Postoperative infections following spine surgery are usually attributable to bacterial organisms. Staphylococcus aureus is known to be the most common single pathogen leading to this infection, and the number of infections caused by methicillin-resistant Staphylococcus aureus is increasing. However, there is a paucity of literature addressing postoperative infection with Mycobacterium tuberculosis. We encountered a case of tuberculous spondylitis after spine surgery. A man had fever with low back pain three weeks after posterior interbody fusion with instrumentation for a herniated intervertebral disc at the L4-L5 level. He had been treated with antibiotics for an extended period of time under the impression that he had a bacterial infection, but his symptoms and laboratory data had not improved. Polymerase chain reaction for Mycobacterium tuberculosis turned out to be positive. The patient's symptoms finally improved when he was treated with antituberculosis medication.

Keyword

Spine; Postoperative infection; Tuberculous spondylitis

MeSH Terms

Adult
Humans
Low Back Pain/etiology
Lumbar Vertebrae/surgery
Male
Postoperative Complications/*microbiology
Spondylitis/etiology/*microbiology
Thoracic Vertebrae/*microbiology/pathology
Tuberculosis/drug therapy/*microbiology
Tuberculosis, Spinal/complications/drug therapy/*microbiology

Figure

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  Fig. 1 Sagittal T1- and T2-weighted images at 4 weeks post-operative. No definite sign of infection was identified.

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  Fig. 2 Sagittal T1- and T2-weighted and contrast-enhanced images at 6 months postoperative. Infectious spondylodiscitis was apparent at L2-S1, and anterior epidural abscess formation was apparent at the L2-L3 level.

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  Fig. 3 Sagittal T1- and T2-weighted and contrast-enhanced images at 13 months postoperative. MRI showed subligamentous extension of inflammation to the T12-L1 intervertebral disc.

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  Fig. 4 Sagittal T1- and T2-weighted and contrast-enhanced images at 22 months postoperative. MRI revealed progression of the bone marrow signal change, with enhancement of the lesion at T10-L1 and increased size of the anterior epidural abscess at T10-T12.

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  Fig. 5 Preoperative and postoperative X-rays for the second operation. After posterior instruments were removed, we performed curettage and grafting with autologous iliac bone at L4-L5 and T10-T11.

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  Fig. 6 X-ray at final follow-up (2.4 years after second operation) showed interbody fusion at L4-L5 and T10-T11.

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