Single vertebra tuberculosis presenting with solitary localized osteolytic lesion in young adult lumbar spines

To describe the clinical and imaging findings in young adults with single vertebra tuberculosis presenting with solitary osteolytic lesions.

Six patients with proven tuberculosis of a single vertebra of the lumbar spine presenting with solitary osteolytic lesion were retrospectively evaluated. There were four male and two female patients with a mean age of 27.6 years (range, 22-38 years). The clinical and imaging features (plain radiographs, CT and MRI) were studied in all six patients.

Involvement occurred from L1 to L5 vertebral levels. The patients presented with local back pain and tenderness but without any obvious deformity of spine or cold abscess. In each case, imaging demonstrated a well-defined, solitary, lytic lesion of average diameter 1.6 cm with thin sclerotic margins within a vertebral body. There were no fragments within the lesions and no paravertebral soft tissue extension around the affected vertebral bodies. The tuberculous eitology was confirmed by CT-guided biopsy in two patients and by curettage of the lesion in four.

Tuberculosis affecting a single vertebral body presenting with a localized solitary osteolytic lesion is an unusual form of single vertebra tuberculosis. MRI combined with CT scan of the vertebral body can be very helpful for precisely defining the location of the lesion and extent of osseous destruction. Such small, solitary, osteolytic lesions are often confused with other single vertebra diseases that can have similar appearances on imaging.