Lumbosacral Spinal Tuberculosis: Clinical Spectrum, Diagnostic Challenges, and Short-Term Management Outcomes in an...

Spinal tuberculosis most commonly affects the thoracic and thoracolumbar spine, whereas lumbosacral involvement is uncommon and may mimic degenerative lumbar spine disorders, often resulting in delayed diagnosis. This study describes the clinical presentation, radiological characteristics, diagnostic challenges, and short-term management outcomes of patients with lumbosacral spinal tuberculosis.

A retrospective observational study was conducted at a tertiary care center between November 2024 and April 2025. A total of 52 patients with suspected infective spinal pathology presenting with chronic non-traumatic low back pain and/or neurological symptoms were evaluated; 19 were diagnosed with spinal tuberculosis. Six patients with lower lumbar or lumbosacral involvement were included in this case series. Clinical features, laboratory findings, imaging characteristics, treatment strategies, and short-term follow-up outcomes were reviewed.

Of the 19 patients diagnosed with spinal tuberculosis, six (31.6%) demonstrated lumbosacral involvement. Patient age ranged from 47 to 83 years, with five patients aged above 60 years. Clinical presentations included chronic low back pain, radiculopathy, neurogenic claudication, motor weakness, and bowel/bladder dysfunction. MRI demonstrated spondylodiscitis with paradiscal involvement in all cases, while prevertebral or psoas collections were observed in two patients. Five patients underwent surgical decompression and stabilization in addition to antitubercular therapy (ATT), whereas one patient was managed conservatively. All patients demonstrated short-term clinical improvement or stabilization during follow-up.

Lumbosacral spinal tuberculosis may present with diverse clinical manifestations that closely resemble degenerative lumbar spine disorders, creating significant diagnostic challenges. Early MRI evaluation and a high index of clinical suspicion are essential for timely diagnosis and treatment. Awareness of this atypical anatomical pattern is essential for timely, multidisciplinary management. These findings are descriptive and intended to generate hypotheses for future prospective research.