An unusual case of extensive contiguous cervicothoracic spinal tuberculosis involving fourteen damaged segments: A case report

Abstract

Introduction: Cervicothoracic spinal tuberculosis (CTSTB) is a rare and disabling disease involving the mobile, transitional zone between the lordotic cervical and the kyphotic thoracic spine. Approximately half of those cases involves one or two segments of cervicothoracic vertebrae. We reported a 28-year-old female with tuberculous involvement of fourteen contiguous vertebral segments.

Presentation of case: A 28-year-old female presented with tuberculous involvement of fourteen contiguous vertebral segments is presented. A series of radiographic and CT scan depicted multiple vertebral body destruction anteriorly, along with facet joint dislocation and mild retrolisthesis of C4-C5 segments. MR images of the cervical region was demonstrated pathologic contrast enhancement on C4 to T7 vertebrae, a total of fourteen contiguous segments.

Discussion: Of all spinal tuberculosis, CTSTB accounts for only 5%. In addition to its rarity as a site for tuberculosis, the cervicothoracic junction has anatomical and clinical peculiarities, as a reversal of the mobile-lordotic cervical vertebrae to rigid-kyphotic thoracic vertebrae occurs at this location. Most CTSTB involves only two segments; however, in this case, we found a very extensive case wherein there were fourteen damaged segments.

Conclusions: Our report demonstrates one of the longest involvement of extensive contiguous CTSTB who was treated with one-stage posterior-only approach. However, as this is only a report of one case, further studies are required to investigate the safety and efficacy of such approach for treating extensive CTSTB.

Keywords: Cervicothoracic spinal tuberculosis; Multilevel contagious involvement.

Fig. 1

Preoperative radiograph of the patient.

Fig. 2

Preoperative CT images demonstrated extensive vertebral body destruction, several facet joint dislocations and mild retrolisthesis of C4 to C5 segment.

Fig. 3

Sagittal cervicothoracic MR images demonstrated pathologic contrast enhancement on C4 to T7 segments along with vertebral body involvement and spinal canal compression at the level of C4 to T4. From coronal MR images, a large paravertebral abscess was presented anteriorly.

Fig. 4

Postoperative radiograph demonstrated pedicle rod and screw construct that resulted in improved kyphotic deformity.