[Multilevel tuberculous spondylitis]

Area of Science:

• Neurosurgery
• Infectious Diseases
• Spinal Surgery

Background:

• Tuberculous spondylitis, also known as Pott's disease, is a significant cause of spinal infection, particularly in endemic regions.
• Disseminated tuberculosis can present with unusual manifestations, including multilevel, non-contiguous spinal involvement.

Observation:

• A 20-year-old HIV-negative male presented with acute paraplegia due to multilevel, non-contiguous tuberculous spondylitis affecting cervical, dorsal, and lumbar spine.
• The patient exhibited severe systemic compromise and multiple disease sites, including draining fistulas, indicative of disseminated tuberculosis.

Findings:

• A complex, three-stage surgical approach was required, involving posterior decompression, anterior cervical corpectomy with reconstruction, and posterior reduction, decompression, and fixation.
• The treatment strategy integrated surgical management, anti-tuberculosis medication, and physiotherapy.

Implications:

• This case highlights the importance of considering disseminated tuberculosis in patients with severe spinal compromise, even in HIV-negative individuals.
• Successful management of rare, extensive Pott's disease requires a multidisciplinary approach, including staged surgical interventions and long-term medical and rehabilitative care.
• Aggressive surgical and medical management can lead to favorable outcomes, including spinal stability and neurological recovery, in complex cases of tuberculous spondylitis.