Tuberculosis Affecting Multiple Vertebral Bodies
The patient was a 77-year-old woman. Other than oral medication for hypertension, her medical history was unremarkable. Lower back pain had begun 11 months prior. This gradually worsened, and fever also appeared. Nine months before she was referred to our department, she was admitted to a general hospital because of difficulty sitting. A fever ranging from 37.5℃ to under 39℃ was observed. Laboratory data showed no elevation of white blood cell (WBC, 3600/µL), but C-reactive protein (CRP) levels were elevated (3.33 mg/dL). Both miliary tuberculosis and multiple bone tuberculosis at levels Th7, 12, L3, 4, 5, the ribs, right ilium, and left ischium were evident. Tuberculosis drug therapy was initiated with four agents. Her fever subsided as the miliary tuberculosis improved, but the lower back pain persisted, and she was referred to our department due to experiencing difficulty in sitting and standing.\nThere was pronounced tenderness in the lumbar vertebrae despite the absence of neurological abnormalities. Radiographic imaging showed osteolytic changes to the vertebral bodies of the lumbar spine, and multiple osteolytic changes at levels Th12, L3, L4, and L5 were evident on computed tomography (CT), which were particularly pronounced in the L4 vertebral body (). Magnetic resonance imaging (MRI) also showed the same inflammatory granulation or abscesses in Th12, L3, L4, and L5 observed on CT (). On the pathological examination of a bone biopsy, Langhans giant cells, caseous necrosis, and acid-fast bacteria were seen, and a diagnosis of spinal tuberculosis was made.\nSurgery was performed because the patient had difficulty sitting due to lower back pain. The surgery involved posterolateral fusion with pedicle screws from L2 to S1 (). Compared to L3, 4, and 5, the vertebral osteolysis in Th12 was mild and not the cause of the lower back pain. Furthermore, as the osteolysis was mild, the probability of vertebral fracture occurring in the future was judged to be low, and, therefore, Th12 was not fused. The patient's postoperative course was uneventful, and her lower back pain improved. As of 18 months postoperatively, the patient was ambulatory.