Solitary tuberculous lesion involving the spinous process of the cervical vertebra

Abstract

The higher incidence and prevalence of tuberculosis (TB) is a common health problem particularly in developing countries like ours. The most common site of TB is the pulmonary region followed by lymph nodes and osteoarticular TB. In the spine, the dorsal spine is the most commonly affected region and the paradiscal being the most common type, posterior elements being the least involved, particularly in isolation. Of the posterior elements, the most common to be involved are the laminae. Here, we are presenting the case of the tubercular osteomyelitis involving the spinous process of the C6 vertebra in isolation. A young female presented to our outpatient department with pain and swelling on the posterior side of the neck. The swelling was nontender, without any signs of acute inflammation, cystic in consistency, and lying deep to the muscles. X-ray of the cervical spine and contrast enhanced magnetic resonance imaging (MRI) suggested the diagnosis of tubercular osteomyelitis. Pus was aspirated. Cartridge-based nucleic acid amplification test revealed Mycobacterium tuberculosis. The patient was given anti-tubercular drugs as per the index TB guidelines of the WHO and was cured. This, to the best of our knowledge, is the only case reported from India. Though the TB of the spinous process is extremely rare, still the diagnosis should be kept in mind when examining a posterior neck swelling, especially in country like ours, where the incidence of TB is high. X-ray and MRI are good tools to reach a diagnosis. Antitubercular regimen should be started for treatment.