Tuberculosis Affecting Multiple Vertebral Bodies
The patient was a 29-year-old Indonesian man. His pre vious medical history was unremarkable. He began to experience back pain 14 months earlier. This gradually worsened, and since fever also appeared, he was admitted to a general hospital 6 months before he was referred to our department. The patient had a persistent fever, ranging from 39℃ to under 41℃. Laboratory data showed no elevation of WBC (WBC, 8200/µL), but inflammatory findings were seen (CRP 12.2 mg/dL; erythrocyte sedimentation rate [ESR], 128/142 mm). He was diagnosed with multiple bone tuberculosis. Furthermore, the patient tested negative on the anti-HIV antibody test and did not have AIDS. Tuberculosis drug therapy was initiated with four agents. Since testing showed that the organism exhibited good sensitivity to the four types of tuberculostatic agents, and the abscesses improved markedly following the start of treatment, the patient did not have multi-drug resistant tuberculosis. The back pain and fever gradually improved, but from 5 months prior to the referral, reduced sensation in both legs and a sense of weakness appeared, and the patient became incapable of walking unaided. His symptoms subsequently progressed further, and he was examined in our department.\nLoss of muscular strength was pronounced, particularly in the right leg, and the patient exhibited difficulty standing. Hypesthesia below Th10 and urinary and defecatory disturbances were evident. The tendon reflex was enhanced in all four limbs, and the Babinski reflex and ankle clonus were both present bilaterally. Radiographic imaging showed widespread osteolytic lesions in the vertebral bodies of the thoracolumbar spine. The CT showed 17 affected vertebral bodies: C3, C4, C6, C7, Th1-8, Th10, L1-3, and L5. Multiple osteolytic changes were evident in C4, C6, Th1, Th3, Th4, Th7, Th8, Th10, L1, and L2, and they were particularly marked in C4, Th1, Th3, Th4, Th7, Th10, and L1 (). MRI also demonstrated the same destruction of multiple vertebral bodies evident on the CT, with compression of the spinal cord by inflammatory granulation and abscesses at Th1/2 and Th3/4 (). Pathological findings from bone biopsy examination showed Langhans giant cells, caseous necrosis, and acid-fast bacteria, and a diagnosis of spinal tuberculosis was made.\nSurgery was performed two months after he was referred to our department due to the paralysis of both legs. Inflammatory granulation and abscesses were seen primarily in the spinal canal and were not observed in the vertebral bodies. We therefore judged that the probability of vertebral osteolysis progressing in the future was low, and that anterior reconstruction was not necessary. We also judged that long fusion would enable the prevention of sequential collapse, and that the posterior single approach was indicated. Therefore, the surgery involved posterolateral fusion with pedicle screws from C6 to Th6 after laminectomy (). The patient's postoperative course was uneventful, and his paralysis improved. Four months after surgery, he was capable of independent gait, and the urinary and defecatory disturbance had also improved. Since the tuberculous spondylitis had resolved one year after use of tuberculostatic agents, treatment regarding the use of these agents was discontinued.