Isolated extradural tuberculous granuloma of the cervical spine: a case report

Abstract

Introduction: Isolated intraspinal extradural tuberculous granuloma (IETG) without radiological evidence of vertebral involvement is uncommon, especially rare in cervical spine.

Materials and methods: We report a case of cervical IETG without bone involvement in a patient with neurological deficit. The patient suffered from progressive neurological dysfunction. MRI of cervical spine revealed an intraspinal extradural mass, and the spinal cord was edematous because of the compression. Thus C2-C4 laminectomy was performed and extradural mass was excised.

Results: The excised extradural mass was confirmed to be tuberculous granuloma through pathologic examination. Antituberculous drugs were administrated with a regular follow-up. Excellent clinical outcomes were achieved.

Conclusions: The isolated IETG, although a rare entity, should be considered in the differential diagnosis of the intraspinal mass, especially in patients with spinal cord compression and a history of tuberculosis. If there is a progressing neurological deficit, a combination of surgical and anti-tuberculous treatment should be the optimal choice.

Fig. 1

A 63-year-old male patient. Both the preoperative posterior-anterior (a) and lateral (b) radiographs of cervical spine didn’t show any bone destruction. Preoperative sagittal T1-weighted (c) and T2-weighted MR images (d) of cervical spine revealed clearly a shuttle-like shape mass with low signal intensity extending from C2 to C4 in the posterior epidural space of the canal with the spinal cord being compressed and edematous (arrows). Postoperative pathological section (e) demonstrated granulomatous tissue with inflammatory cells and caseous necrosis (arrows in E, HE stain, ×100) and photomicrograph (f) showed positive tissue staining for acid-fast bacilli (arrow in f, acid-fast stain, ×1000)