An Older Woman with Buckling Spinal Deformity: A Spinal Tuberculosis Outcome

Abstract

A 65-yr-old woman was admitted to our clinic with the complaints of back pain and gibbus deformity for the last 20 yrs. She declared that the pain had increased during the previous year and that it was especially worse with standing and/or walking. Her medical history was unremarkable other than spinal tuberculosis and kyphosis. She did not give any history of trauma, and she did not have any corrective surgery for kyphosis. The physical examination revealed prominent kyphosis at the thoraco-lumbar region. Passive and active low back range of motion was limited and painful. The neurologic examination was normal. Laboratory tests were unremarkable. Magnetic resonance imaging (Fig. 1) demonstrated kyphosis and collapse of several thoraco-lumbar vertebrae.FIGURE 1: T1-weighted sagittal magnetic resonance imaging (MRI) of the lumbar spine showing total collapse of the T12 and L2 vertebrae and buckling deformity at the thoraco-lumbar junction. An L2 vertebra was fused with L3 vertebra.Involvement of the spine is encountered in 1–2% among the estimated 400 million cases of tuberculosis worldwide.1 Thoracic disease is the most common (80%), followed by involvement of the lumbosacral (15%) and cervical spine (5%).1 Spinal tuberculosis is the most common cause for kyphotic deformity in many parts of the world.2 Severe kyphosis following spinal tuberculosis leads to cosmetically and functionally disabling results.2 Neurologic deficits are reported in 10–60% (mean 20%) of cases with spinal tuberculosis, and the clinical scenario encompasses somatosensory changes, paresthesias, and changes of bowel and bladder functions.1 Magnetic resonance imaging clearly shows the extent and pattern of bony destruction in these patients,2 who may also have compromised cardiopulmonary function and painful costopelvic impingement.3 Kyphosis and severe spinal deformity secondary to spinal tuberculosis causes neurologic deficits, pain, and disability. However, in this case, our patient did not have paraplegia or incontinence. To conclude, patients who have a history of spinal tuberculosis should be followed closely to prevent undesirable results.