A Rarely Occurring Spinal Fracture Precipitated by Generalized Spasms of Tetanus Patient with Spondylitis Tuberculosis

Abstract

Background: The occurrence of spinal fracture due to tetanus nowadays is extremely rare, as compared to the 1950s, since the widely available anti-tetanus and antispasmodic therapy. The spinal fracture in tetanus patients is usually reported in higher thoracic vertebrae, previously with a rate as high as 57.5%. Spondylitis is the most common form of skeletal tuberculosis (TB) and can cause a spinal fracture. In Indonesia, tetanus is still reported, while tuberculosis is still endemic; however, co-infection of both diseases is rarely reported.

Case presentation: A 36-year-old male was brought to our hospital with jaw stiffness, accompanied by fever. A history of dental cavities was present, and 5 days prior, he experienced a fishing hook wound on his right index finger. There was no history of TB. Physical examination showed meningismus, 2 cm trismus, abdominal spasm, opisthotonus, and spontaneous muscle spasms, without dysautonomia. In the third week of hospitalization, while his tetanus condition improved, he complained of weakness in both legs. A thorough history taking revealed a history of backache for 3 years. A wedge-shaped fracture on his 11th and 12th thoracic vertebrae was observed on radiographic examination. A spinal TB diagnosis was made, and treatment was started. He refused to get spinal surgery, then went home with 4 out of 5 motor strength scale. After three months, he returned to his routine activity as a food hawker with no motor deficits.

Conclusion: Tetanus spinal fracture is extremely rare nowadays; a thorough history of spinal problems/medication is compulsory for anticipation. This patient's spinal fracture was deemed due to a preexisting TB spinal infection that was precipitated by prolonged continuous tetanic spasm due to general tetanus.

Keywords: infection; medulla spinalis; paraparesis inferior; spinal fracture; spondylitis tuberculosis; tetanus.

Figure 1

Spinal fracture of the 11th-12th thoracal vertebrae and imaging. (A) Spinal fracture is clearly visible from inspection of the patient’s back. (B and C) an AP and lateral x-ray shows a wedge-shaped fracture on the 11th-12th thoracal vertebra, (D–L) T2 sequence MRI images of patient vertebrae show a wedge shape fracture on the 11th-12th thoracal vertebra, accompanied with paravertebral abscess (arrow). X-ray: (B) AB view. (C) lateral view. MRI: (D, J–L) coronal view. (E, F and I) sagittal view. (G and H) axial view.

Figure 2

Patient’s condition 3 months after discharge. The patient is able to tiptoe walking (A), continues his work as a food hawker (B), and sits (C) without any difficulty or pain.