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S1 tuberculosis treated with segmental lumbopelvic fixation: a case report
Sambhav P Shah1, Arvind G Kulkarni
1Department of Orthopaedics, Bombay Hospital, New Wing, Medical Research Centre, Mumbai, Maharashtra, India.
Study Design:
A case report.
Objective:
To describe an effective surgical option for sacral tuberculosis (TB).
Summary Of Background Data:
Sacral TB is a rare cause of low back pain. A differential diagnosis of TB should always be made, especially in India where TB cases are on a rampant rise with increasing drug resistance and immunosuppressed population.
Methods:
A retrospective review. RESULTS.: We report on a 24-year-old woman with low back pain and radiculopathy. Magnetic Resonance Imaging (MRI) showed a destructive lesion in S1 body. Empirical antitubercular treatment was started elsewhere with no relief but worsening of the lesion. She underwent a Computed Tomography (CT)-guided biopsy and drug sensitivity test, which did not reveal anything. The patient was bedridden for almost a year. A lumbopelvic instrumented fixation and S1 body reconstruction with structural allograft was performed. Culture sensitivity revealed multidrug resistance. After surgery, the patient responded rapidly, and at 2-year follow-up, she is symptom-free.
Conclusion:
TB should always be considered as a differential diagnosis of sacral lesions, and identifying multidrug resistance is equally important in its treatment. Lumbopelvic fixation is a safe and reliable option as it unloads the S1 segment by achieving fixation in the lumbosacral spine and iliac wings.
