Tuberculosis Of Cervical Spine Research Articles

Surgical management and clinical outcome of cervical, thoracic and thoracolumbar spinal tuberculosis in a middle-European adult population

Spinal tuberculosis is due to globalization no longer a disease limited to developing nations. It remains in Germany a rarity and still a difficult diagnosis. Here we analyzed patients with spinal tuberculosis treated at our neurosurgical department. According to the infected anatomic segment, patients were assigned in one of three groups. Surgery was performed when neurological deficit due to mechanical compression, deformity, instability, severe pain, necrotic bone or failure to respond to anti-tuberculous treatment were observed. We identified 34 patients with spinal tuberculosis who underwent surgical treatment. In the cervical spinal tuberculosis group, there were 15 cases (46.9%) In most cases treatment consisted of spinal instrumentation. In the thoracic group, 10 cases (29.4%) were observed. The treatment was performed by dorsolateral spinal instrumentation. For the thoracolumbar group, 9 cases (26.4%) were observed. In most cases dorsolateral spinal instrumentation was performed. One patient in the first group and one patient in the third group relapsed after operation. A second surgery was necessary. Patients with chronic back pain, immigration background and/or neurological deficit spinal TB should be considered as a differential diagnosis. Combined surgical intervention and medical treatment is associated with a favorable outcome.

The surgical approach and clinical results for cervical spine tuberculosis: A retrospective study in 15cases

The surgical approach and clinical results for cervical spine tuberculosis: A retrospective study in 15cases

Imaging review in case of cervical spine tuberculosis

Tuberculosis of the cervical spine differs from other vertebral localizations by its extreme rarity, the clinical images are very diversified, the radiological measurements allow a good diagnostic orientation and specifically the MRI which allows a multi-planar study of the various lesions. Only bacteriological evidence can confirm the diagnosis. The treatment is based on a 12-month antituberculosis multidrug therapy and much debate upon the surgical indication. History: In this case, the patient presented with pain in cervical region with restricted movements of the neck and pain on examination at the mobilization of the cervical spine. Biopsy of the cervical lymph node had already been done which was positive for Koch’s etiology. Discussion: Cervical CT scan and a cervical MRI were performed, showing changes of spondylitis involving C1-C3 vertebrae with adjacent large loculated abscess in prevertebral and bilateral paravertebral regions and cord compression at the level of C2 vertebrae. Findings favoring an infective etiology. Conclusion: Cervical spine tuberculosis is considered a catastrophic disease due to the associated probability of spinal cord compression and quadriplegia. This emphasizes the importance of early diagnosis in the management of cervical tuberculosis with radiological and clinicopathological correlation.

Efficacy of anterior debridement and bone grafting with fusion using internal fixation combined with anti-tuberculosis chemotherapy in the treatment of subaxial cervical tuberculosis

BackgroundTo evaluate the efficacy of anterior debridement and bone grafting with fusion using internal fixation (BFIF) combined with anti-tuberculosis chemotherapy in the treatment of subaxial cervical spine tuberculosis (SCS-TB).MethodsClinical and radiographic data of patients with SCS-TB treated by anterior debridement and BFIF at our hospital from January 2010 to December 2017 were analyzed retrospectively. The SCS sagittal parameters at the preoperative, postoperative, and final follow-up were documented and compared, including the Occiput-C2 angle, C2–C7 Cobb angle, local Cobb angle, spinal canal angle (SCA), C2–C7 sagittal vertical axis (C2–C7 SVA), the center of gravity of the head-C7 sagittal vertical axis (CGH-C7 SVA), T1 slope (T1S), neck tilt (NT), and thoracic inlet angle (TIA). The ASIA grade, NDI index, JOA score, and VAS score were utilized to assess the postoperative function recovery, and the complications were recorded.ResultsA total of 23 patients were included in the study with a mean age of 46.74 ± 15.43 years, including 8 males and 15 females. All patients with SCS-TB were treated with anterior debridement and BFIF, with a mean postoperative follow-up time of 37.17 ± 12.26 months. The poisoning symptoms of TB were relieved in all patients, and ESR (42.09 ± 9.53 vs 8.04 ± 5.41, P < 0.05) and CRP (30.37 ± 16.02 vs 7.4 ± 2.68, P < 0.05) were decreased at the 3 postoperative months in the comparison of the preoperative. The C0–C2 Cobb angle, C2–C7 Cobb angle, local Cobb angle, SCA, TIS, C2–C7 SVA, and CGH-C7 SVA were corrected remarkably after surgery (P < 0.05). Further, there was a significant improvement in the JOA, VAS, and NDI with the comparison of the preoperative (P < 0.05).ConclusionsAnterior debridement and BFIF combined with anti-TB chemotherapy was a practical tool for the treatment of SCS-TB with the help of SCS sagittal parameters, which can remove the lesion completely, decompress the spinal cord compression, and correct the kyphotic deformity to restore the spine sagittal balance.

Anterior debridement, bone grafting and fixation for cervical spine tuberculosis: an iliac bone graft versus a structural manubrium graft

BackgroundAnterior debridement, decompression, bone grafting, and instrumentation are safe and effective techniques for patients with lower cervical spine tuberculosis. However, there is no consensus regarding the methods for using autogenous bone grafts. The purpose of this retrospective study was to compare the clinical outcomes of anterior surgical management for cervical spine tuberculosis by using an iliac bone graft versus a structural manubrium graft.MethodsFrom January 2009 to September 2018, 23 patients with cervical spine tuberculosis were treated with anterior debridement, autogenous structural bone grafting and fixation at our spinal department. The patients were divided into 2 groups according to the different graft materials, namely, iliac crest bone grafts (Group A) and structural manubrium grafts (Group B). The clinical and radiographic results of the 2 groups were analyzed and compared.ResultsThe mean duration of follow-up was 24 months. Bony fusion was achieved in all patients without failure of internal fixation. There were no significant differences between the two groups with respect to the operation time, blood loss, fusion time, neurological outcomes, or postoperative local Cobb angle (P > .05). However, the donor site complication rate in Group A was greater than that in Group B. The postoperative ambulation time in Group A was later than that in Group B. The mean visual analog scale (VAS) score for donor site pain in Group A was higher than that in Group B at 1 week after surgery (P < 0.05). However, there was no significant difference between the 2 groups at the last visit (P > .05).ConclusionBoth iliac bone grafts and sternal manubrium grafts can effectively reconstruct anterior column defects in anterior surgery. However, structural sternal manubrium autografts cause fewer complications associated with donor site morbidities than iliac bone grafts.

Endoscopy-assisted anterior cervical debridement combined with posterior fixation and fusion for the treatment of upper cervical spine tuberculosis: a retrospective feasibility study

BackgroundThis retrospective study aimed to determine the feasibility and efficacy of endoscopy-assisted anterior cervical debridement combined with posterior fixation and fusion in patients with upper cervical spine tuberculosis.MethodsBetween June 2008 and January 2016, 17 patients (10 men and 7 women) with upper cervical spine tuberculosis underwent endoscopy-assisted anterior cervical debridement combined with posterior fixation and fusion. Anti-tuberculosis treatment was administered for 2–4 weeks preoperatively and 12–18 months postoperatively. The clinical and radiographic data of the patients were analyzed.ResultsThe operation was successfully completed in all patients. Neck pain and stiffness were relieved after the surgery in all patients. The mean operation time was 210.0 ± 21.2 min, and the mean intraoperative blood loss was 364.7 ± 49.6 mL. The mean follow-up duration was 68.1 ± 6.7 months. The erythrocyte sedimentation rate returned to normal by 3 months postoperatively. Visual analog scale scores for neck pain were significantly lower postoperatively than preoperatively. All patients had significant postoperative neurological improvement. Patient-reported outcomes, as measured using the Kirkaldy-Willis criteria, were as follows: excellent, 12 patients; good, 4 patients; fair, 1 patient; and poor, 0 patients. Bone fusion was achieved at 10.9 ± 1.9 months after the surgery; no cases of instrument loosening or fracture occurred.ConclusionEndoscopy-assisted anterior cervical debridement combined with posterior fixation and fusion is a feasible and effective surgical method for the treatment of upper cervical spine tuberculosis. It can be used to restore upper cervical spine stability and facilitate spinal healing.

Efficacy of deep tissue laser therapy in pressure ulcer healing in patient with quadriplegia: Case Report

CONTEXT: Pressure ulcers (PU) are the most common complication noted in bed-ridden patients. The purpose of this case report is to explore the efficacy of class IV near-infrared laser therapy in the treatment of large and severe pressure ulcers. FINDINGS: A 53-years-old male diagnosed with quadriplegia due to cervical spine tuberculosis at level C5-C6 was admitted to a hospital with an unstageable pressure ulcer over the sacrum and National Pressure Ulcer Advisory Panel Pressure stage 3 ulcers over the right trochanteric area for pressure injury. No associated comorbidities like diabetes mellitus and hypertension were present. The Lite Cure Gallium-Aluminum-Arsenide (GaAlAs) class IV near-infrared laser, non-contact, continuous beam emission (non-pulsing) at 980nm wavelength, was used. The dosage parameters used were: 7.5 - 10 watts power; dose range 7 J/cm2 - 9 J/cm2; sacral area (13×9) cm2 and trochanteric area (10×8) cm2; at varying energy densities; treatment time ranges between 8 to 15 minutes for each ulcer. Total 19 sessions over 6 weeks were given to treat pressure ulcers. Dimensions (area) and severity stage of pressure ulcer were noted pre-intervention and after the intervention. The post-treatment data revealed the clinical improvement in both outcomes. CONCLUSION/CLINICAL SIGNIFICANCE: This case report demonstrates the anti-inflammatory, analgesic, and bio-stimulative healing effects of Class IV laser therapy treatment showing a reduction in the dimensions and severity of pressure ulcers.

Upper cervical spine tuberculosis

Tuberculosis is an infection caused by Mycobacterium tuberculosis; mainly affects the lungs; spinal tuberculosis presents 6 % of the extrapulmonary locations; Upper cervical spine tuberculosis is a rare condition and counts only 0.3 to 1 % of all spinal tuberculosis; that makes it a rare condition studied by few case reports. We report a case of upper cervical spine tuberculosis of the atlantoaxial facet joint.

Retropharyngeal abscess causing grisel’s syndrome secondary to tuberculosis of cervical spine, a rare form of torticollis: case report

&lt;p&gt;Grisel’s syndrome is a rare type of non-traumatic subluxation of an atlantoaxial joint characterized by torticollis, neck pain, and reduced neck movement. The common causes of Grisel’s syndrome are head and neck infection or post-otorhinolaryngology (ORL) procedures. We are reporting a case of a 3-year-old boy with a gradual worsening of neck stiffness, neck pain, and restricted neck movement for more than one month. The patient had no history of trauma. The computerized tomographic (CT) showed a retropharyngeal abscess with a bony erosion causing atlantoaxial subluxation. The management and progress of this patient are discussed. The objective of this case report is to emphasize that Grisel’s syndrome should be considered a differential in a painful torticollis to prompt an early diagnosis and treatment to prevent serious neurological complications.&lt;/p&gt;

Outcome Analysis of Subaxial Cervical Spine Tuberculosis Operated by the Anterior Approach: A Single-Center Experience.

Though spinal tuberculosis has a predilection for the dorsal and lumbar spine, a high percentage of morbidity and mortality is associated with cervical tuberculosis. Cervical tuberculosis accounts for about 10% of cases, with the major concerns being quadriparesis/quadriplegia and kyphotic deformity. Herein we describe our experience with the use of anterior instrumentation with titanium implants in 46 patients with subaxial tuberculosis. Included in the study were a total of 46 patients with subaxial cervical (C3-C7) and upper dorsal (D1-D3) tuberculosis who underwent operations with anterior debridement, decompression, bone grafting, and anterior instrumentation by a single surgeon at our institute between January 2007 and December 2014. A review of the demographic data, medical records, and x-rays before and after surgery and at subsequent follow-ups was performed retrospectively from the departmental database. Neurological involvement in the postoperative period was seen in 29 of the 30 patients, 26 of whom showed complete neurological recovery. The Cobb angle at presentation ranged from 2°-58° of kyphosis with an average kyphosis of 15.4°. The average lordosis after surgery was found to be 17.5° (ie, a mean correction of 32.9°). Anterior instrumentation of subaxial cervical tuberculosis with titanium implants provides good correction of kyphosis and provides reasonable neurologic recovery in patients and ensures a long-lasting functional outcome. 4.

Giant Tuberculous Retropharyngeal Abscess with Associated Neurological Manifestations in Cervical Pott's Disease

Retropharyngeal abscess is a relatively uncommon pathology that predominantly occurs in the pediatric age group. Tuberculous retropharyngeal abscess (TBRPA) is relatively rare. TBRPA in a 13-year-old female child was reported. She presented with neck pain, restricted neck movements, right upper limb weakness, dysphagia, odynophagia, and weight loss. Radiological imaging showed upper cervical spine tuberculosis with a giant retropharyngeal abscess. She underwent drainage of pus and stabilization of the upper cervical spine. Subsequently, she received antituberculous therapy for 18 months. Postsurgery, her clinical symptoms improved. At a 1-year follow-up, there was no evidence of recurrence of the tuberculous lesion.

Treatment for tuberculosis of the subaxial cervical spine: a systematic review.

To systematically review the clinical manifestations and treatment outcomes of patients with subaxial cervical spinal tuberculosis (SCS-TB) and evaluate the current evidence for surgical or nonsurgical treatment. A systematic review was performed using the PubMed, ScienceDirect, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Studies published in English from January 2000 to December 2018 were included in the search. A reference lists search of relevant articles was also conducted for other potential references. The risk of bias was assessed with the 13-item criteria recommended by the Cochrane Back and Neck Group and the Methodological Index for Non-Randomized Studies. Fifteen articles were included with a total of 456 patients, of which only 1 study was randomized and fourteen were nonrandomized. The most common symptom reported was neck pain and stiffness, and the most common segment involved was C5. Of the 456 patients, 329 (72.1%) were treated surgically. Most experienced neurologic recovery after surgery. Instrumentation resulted in maintenance of the correction of alignment throughout the follow-up period. The use of radical debridement is still in debate. Anti-TB therapy is necessary for all SCS-TB patients, including those underwent surgical management. For patients with neurological dysfunction, the surgical method with decompression and instrumentation could provide better cervical spinal alignment and stability. For adult, the radical debridement remains in debate, while for children, radical debridement may cause the development of progressive kyphosis during growth. Larger randomized comparative studies with longer follow-up times are needed.

Iatrogenic biological fracture of the cervical spine during gradual halo traction for kyphotic deformity correction: case report

BackgroundSevere kyphotic deformities carry high risk for neurological injuries as osteotomies are often required for correction. Surgeons often utilize a staged approach for dealing with these conditions starting with a period of halo traction to stretch tight soft tissues and partially correct the deformity, followed by surgery. Halo traction is a relatively safe procedure and complications are uncommon. We report a unique case of iatrogenic fracture of the cervical spine during gradual halo traction for deformity correction of a severe cervical kyphosis.Case presentationAn 80-year-old female with previous cervical spine tuberculosis infection and C5-C6 anterior spinal fusion developed severe cervical kyphosis of 64° from C2-C6 and neck pain requiring deformity correction surgery. Gradual increase in traction weight was applied, aiming for a maximum traction weight of 45 pounds or half body weight. During the 1st stage halo-gravity traction, sudden neck pain and a loud cracking sound was witnessed during increase of the traction weight to 14 pounds. Imaging revealed a fracture through the C4 and reduction in kyphosis deformity to 11° from C2-C6. There was no neurological deficit. No further traction was applied and the patient underwent an in-situ occipital to T3 fusion without osteotomies. At 3-year follow-up, the patient was symptom-free and radiographs showed solid fusion and maintenance of alignment.ConclusionsIatrogenic fracture may occur with halo traction. Elderly patients with osteoporotic and diseased bone should be closely monitored during the treatment. A fracture without complications was a fortunate complication as the patient was able to avoid any high-risk osteotomies for deformity correction.Level of evidenceIV

Does kyphosis in healed subaxial cervical spine tuberculosis equate to a poor functional outcome?

Introduction:Tuberculosis (TB) of the subaxial cervical spine has a high percentage of morbidity. It accounts for about 10% of cases with the major concerns being quadriparesis and localized kyphosis.Aim:The study aims to provide an insight in the management of subaxial cervical spine TB treated by multiple modalities.Materials and Methods:A retrospective analysis of 91 patients with subaxial cervical (C3–C7) TB was performed. Neurology was assessed by Nurick's grading and pain using the visual analog scale (VAS) (in mm). Radiological evaluation was done with standard anteroposterior and lateral view of the cervical spine at presentation and 3 monthly intervals after intervention. Magnetic resonance imaging was done in all patients. Angle of kyphosis (K angle) was calculated from plain radiographs.Results:Mean age of the patients was 31.5 years. Neurological status was Nurick's Grade 5 in 8, Grade 4 in 15, Grade 3 in 28, Grade 2 in 22, Grade 1 in 7, and further 11 had Nurick's Grade 0. Operative intervention was either anterior, or posterior, or a combination of both depending on extent of vertebral destruction. All patients with Nurick's 5 and 4 improved to 3 or less at final follow-up. The kyphosis angle at presentation ranged from 2° to 58° of with an average kyphosis of 16.05°. The postoperative kyphosis was graded as mild (loss of lordosis to 10° kyphosis), moderate (10°–30°), and severe (>30°). Ten patients had mild kyphosis and 6 patients had moderate kyphosis. Mean VAS score at presentation was 45.5 mm which improved to 14.48 mm at follow-up. Patients with mild and moderate kyphosis remained asymptomatic till the last follow-up.Conclusion:Healing of subaxial cervical TB in kyphosis does not necessitate a poor clinical outcome as most patients remain asymptomatic.

More complications in cervical than in non-cervical spine tuberculosis

Purpose: Cervical spine tuberculosis (CST) is a rare disease that may lead to severe neurological complications. The goal of the study was to compare the characteristics of patients with CST with those of patients with non-cervical spine tuberculosis (NCST).Methods: Between 1997 and 2016, we reviewed all cases of proven tuberculosis from a cohort of spine infections in a tertiary care hospital. Clinical, biological, and imaging data were collected at baseline and after treatment.Results: Fifty-one cases of spine tuberculosis were included: 14 with CST on imaging (27%) and 37 with no cervical localization. Median age was 39 y. Demographic characteristics, duration of symptoms and neurological findings of spine compression were similarly present at presentation in CST and NCST patients. On imaging, lesions were more often multifocal in CST than in NCST patients (9/14 [64%] versus 10/37 [27%], p = .014). Spinal surgery was required in 32/51 (63%) patients. At the end of follow-up (median: 20 months), cure rates were similar in CST and NCST patients but motor and/or sensitive functional sequel were more frequent in CST than NCST patients (6/14 [43%] versus 2/37 [5%], p = .003).Conclusions: Cervical involvement is present in more than a quarter of patients with spinal tuberculosis. Patients with CST had more frequent neurological sequelae than patients with NCST. This was mainly due to a more multifocal disease at presentation. Screening for cervical localization should be systematic in patients with spinal tuberculosis even in the absence of cervical symptoms.

A multicenter retrospective research of anterior debridement, decompression, bone grafting, and instrumentation for cervical tuberculosis

ABSTRACTObjective: To observe the clinical effect of anterior debridement, decompression, bone grafting, and instrumentation for cervical spinal tuberculosis in four hospitals.Materials and Methods: This research retrospectively analyzed 146 patients with cervical spinal tuberculosis who were treated by anterior debridement, decompression, bone grafting, and instrumentation in four institutions between January 2000 and January 2015. There were 68 males and 78 females with an average age of 31.32 ± 11.69 years. All patients received chemotherapy for 18 months after surgery, and fixed by brace for 3 months. Clinical outcome, laboratory indexes and radiological results were analyzed to evaluate the efficacy of anterior approach surgery in the treatment of cervical spinal tuberculosis.Results: All cases were followed up about 18 to 52 months later (average 24 months). At the last follow-up, all patients obtained bone fusion, pain relief and neurological recovery. There was no recurrence in any of the patients, and no complications related to internal fixation. There were statistically significant differences before and after treatment in terms of Visual analog scale (VAS), Neck disability index (NDI) and Japanese Orthopedic Association (JOA)(P < 0.05). During the last follow-up examination, in 83 patients with neurological deficit, 78 patients improved. The kyphosis was significantly improved postoperatively (P < 0.05). At the last follow-up, the Cobb angle had some degree of correction loss, but the difference was not statistically significant.Conclusion: Our study suggests that one-stage anterior debridement, decompression, bone grafting, and instrumentation are safe and effective methods in the surgical management of cervical spinal tuberculosis.Abbreviation: VAS: Visual Analog Scale; JOA: Japanese Orthopaedic Association; NDI: Neck Disability Index; ESR: Erythrocyte Sedimentation Rate; ASIA: American Spinal Injury Association; TB: Tuberculosis

Anterior debridement, decompression, fusion and instrumentation for lower cervical spine tuberculosis

BackgroundAntituberculosis chemotherapy have been widely used for lower cervical spine tuberculosis and brought out favorable outcomes. However, the contribution of surgical treatment is not well investigated yet. Therefore, this study aimed to evaluate the clinical efficacy and feasibility of surgical treatment for lower cervical spine tuberculosis by anterior debridement, decompression, fusion and instrumentation. MethodsFrom April 2011 to July 2016, 17 patients (9 males and 8 females, average age, 45.7 ± 16.8 years) with lower cervical spine tuberculosis (C4–C7) underwent anterior debridement, decompression, fusion and instrumentation. Frankel grading and visual analogue scale were used to assess neurological function and neck pain, respectively. Operating time, blood loss, erythrocyte sedimentation rate, C-reactive protein, kyphosis angle and postoperative complications were used to evaluate the clinical outcomes of surgery. ResultsThe surgery duration time range from 78 to 322 min (average 136.2 ± 61.1 min) and the blood loss range from 50 to 500 ml (average 127.7 ± 110.9 ml). Kyphosis angle was 10.8 ± 11.8°on average preoperative and returned to −6.3 ± 10.4° postoperative (P < 0.001, t = 12.3) and remained −4.4 ± 9.9°at final follow-up (P < 0.001, t = 11.8). The average preoperative and final follow-up visual analogue scale scores were 4.6 ± 1.3 and 0.6 ± 0.5 respectively (P < 0.001, t = 13.5). The erythrocyte sedimentation rate and C-reactive protein decreased gradually postoperative and returned to normal at final follow-up. No postoperative severe complications and no recurrence of tuberculosis occurred in all cases and neurologic function was improved in various degrees. ConclusionAnterior debridement, decompression, fusion and instrumentation could serve as an effective treatment in the management of the lower cervical spine tuberculosis.

Could Allograft Bones Combined with Poly-Ether-Ether-Ketone Cages or Titanium Mesh Cages be an Alternative Grafting Method in the Management of Cervical Spinal Tuberculosis?

To investigate the effectiveness of allograft bones combined with poly-ether-ether-ketone (PEEK) cages or titanium mesh cages (TMCs) in the management of cervical spinal tuberculosis. A total of 16 patients with cervical spinal tuberculosis who underwent anterior debridement, reconstruction with allograft bones combined with PEEK cages or TMCs, and anterior plate fixation between 2013 and 2016 were retrospectively studied. Neck pain, neurologic status, operating time, intraoperative blood loss, cervical spine alignment, bony fusion, and self-reported clinical outcomes were reviewed. Six patients underwent 1 level reconstruction using PEEK cages and 10 patients received TMCs reconstruction. Patients received a mean follow-up time of 45.9 ± 13.1 months. Neck pain was greatly relieved, as visual analog scale scores decreased from 4.6 ± 1.3 preoperatively to 0.7 ± 0.5 at the final follow-up (P < 0.05). Neurologic status was improved in all patients with neurologic deficits, with 9 patients improving by 1 grade and 1 patient by 2 grades. Kyphosis angle was corrected from 1.3 ± 12.0 degrees preoperatively to -5.4 ± 10.2 degrees postoperatively (P < 0.05) and remained at -3.6 ± 9.6 degrees at the final follow-up (P < 0.05). Bony fusion was achieved in all patients, with a mean time to the fusion of 3.8 ± 1.3 months. There was no implant failure or signs of cervical spinal tuberculosis recurrence. Excellent results, good results, and fair results were reported in 37.5%, 56.25%, and 6.25% of patients, respectively. Allograft bone combined with PEEK cages and TMCs could bring about favorable clinical results in patients with cervical spinal tuberculosis. This method could be an alternative to autologous bone grafting method in the management of certain cases.

Non-Contiguous Multi-Visceral and Vertebral-Medullary Multifocal Tuberculosis in Immunocompetent Subject

Tuberculosis is an infectious disease caused by the bacillus of Koch (BK). The multifocal form is usually associated with the immunosuppression of HIV. In this regard, we report an unusual case of multifocal tuberculosis associating visceral foci with a non-contiguous cervical, dorsal and lumbar spinal tuberculosis, in an immunocompetent subject. The patient had a medical-surgical treatment. It is a disease with a difficult diagnosis. We will discuss, in this case, the clinical, diagnostic, and therapeutic characteristics of this clinical entity.

Cervical Pain and Tuberculosis: Case Report

The presenting symptoms of tuberculosis (TB) are varied and may include acute and chronic pain in anatomical regions with active TB infection. Cervical spine TB, although rare, can present with nonspecific symptomatology emanating from the upper cervical spine, leading providers to overlook TB in their diagnostic approach. This case report demonstrates the necessity of a thorough history and physical with particular emphasis on pertinent sociodemographic risk factors for pain medicine clinicians to reliably ensure accurate diagnosis and treatment. A patient with TB of the cervical spine presented as a referral with pain symptoms refractory to standard pharmacologic analgesic regimens. Only with a thorough social history, made difficult by language and sociodemographic barriers, were we able to direct our diagnostic approach to elucidate the etiology, and engage the patient with the appropriate therapy. Key words: Tuberculosis, cervicalgia, cervical spine, extrapulmonary tuberculosis, pregabalin, social history