RAPID PROGRESSION OF SPINAL TUBERCULOSIS: A CASE REPORT AND LITERATURE REVIEW

Abstract

ABSTRACT Of bone tuberculosis cases, 50% correspond to vertebral tuberculosis. It presents with severe kyphosis in the dorsal region and, to a lesser extent, with neurological deficits secondary to bone destruction, due to direct compression from abscesses, inflammatory tissue, or secondary instability from fractures and vertebral wedging. A 33-year-old male was admitted with a one-month history of lumbar pain, initially attributed to disc herniations. The condition progressed with intense radicular lumbar pain. Imaging studies showed L3-L4 spondylodiscitis, which rapidly progressed to vertebral destruction and neurological deficits. A right L2-L3 hemilaminectomy and epidural abscess drainage were performed. The patient continued to experience lumbar pain. Postoperative CT showed significant vertebral bone destruction, prompting a new surgery: L2-L3 laminectomy, transpedicular fixation, and autograft arthrodesis, achieving extensive decompression and vertebral stabilization. The real-time PCR study (Gen Xpert®) and histopathological analysis were consistent with vertebral tuberculosis. Hypoalbuminemia was identified as a risk factor for the rapid progression of vertebral tuberculosis. Vertebral tuberculosis can progress rapidly, especially in patients with risk factors that compromise their immune and nutritional response, such as in children, hypoalbuminemia, vitamin D and B12 deficiencies, resistance to antitubercular drugs, and HIV coinfection. Spinal tuberculosis has various risk factors that contribute to its rapid progression and bone destruction. Level of Evidence IV; Cases Series.