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Tertiary syphilis in the lumbar spine: a case report
Yang Bai1, Feng Niu2, Lidi Liu2
1Department of Cardiac Surgery, The First Hospital of Jilin University, Changchun, 130021, China.
BMC Infectious Diseases
|July 26, 2017
Summary
Tertiary syphilis spinal lesions causing cauda equina compression are rare and difficult to diagnose. Surgical intervention may aid neuropathy but carries risks like Charcot
Area of Science:
- Neurology
- Orthopedic Surgery
- Infectious Diseases
Background:
- Tertiary syphilis spinal involvement with destructive bone lesions is exceptionally rare.
- Diagnosis is challenging, often requiring more than radiographic and histological analysis.
- Limited data exist on surgical interventions for syphilitic spinal lesions.
Observation:
- A 44-year-old male presented with chronic low back pain and acute radiating lower extremity pain.
- Radiological findings revealed osteolytic lesions and new bone formation in L4-L5 vertebral bodies.
- Positive serum Treponema pallidum hemagglutination (TPHA) confirmed syphilis.
Findings:
- Surgical debridement, fusion, and instrumentation were performed for cauda equina compression.
- Postoperative low back pain and numbness improved, but graft absorption and instrumentation failure occurred.
- Development of Charcot's arthropathy between L4 and L5 was noted as a complication.
Implications:
- Diagnosing spinal tertiary syphilis remains a significant clinical challenge.
- Surgery can be a valuable adjunct to antibiotic therapy for syphilitic spinal neuropathy.
- Charcot's arthropathy is a potential complication following surgical treatment.
