Tuberculosis of the spine: A case report and review of the literature [Tubercolosi della colonna vertebrale: Caso clinico e revisione della Letteratura]

We report a case of spinal tuberculosis (Pott's Disease) in a 83 year-old woman. She had longstanding back pain and progressive neurological deficit. Vertebral MRI showed tuberculous spondylitis. The patient underwent computed tomography (CT)-guided needle biopsy of the D6-D7 lesion. Histological examination revealed necrosis without granulomas. Acid-fast bacilli cultures were positive for Mycobacterium tuberculosis. She was placed on a 6-month course of isoniazid and rifampin, plus pyrazinamide and ethambutol for the first two months. The spine is the most frequent location of musculoskeletal TB. Advanced disease mimics other infections and malignancy. Tuberculous spinal infections should be suspected in patients with an insidious, progressive history of back pain, especially when the thoracic vertebrae are affected and a pattern of bone destruction with relative disc preservation and paravertebral and epidural soft tissue masses are observed. Doctors are unfamiliar with the skeletal manifestations of the tuberculous disease. These factors could explain the delay of the diagnosis and the progressive neurological deficit.