Tuberculous spondylitis and paravertebral abscess formation after kyphoplasty: a case report.
METHODS
Case report.


OBJECTIVE
To report a patient with spinal tuberculosis (TB) and paravertebral abscess formation after kyphoplasty of L1. The literature is reviewed, and diagnostic options are discussed.


BACKGROUND
Kyphoplasty is a well-established procedure in the treatment of osteoporotic compression fractures and metastatic tumors of the vertebrae. Although complication rates are low, there is evidence for an increased risk of serious local infections after kyphoplasty in patients with any history of systemic infection. Spinal TB accounts for 2% of all TB cases with a trend toward an increased incidence in parallel with the growing number of immunocompromised patients. To our knowledge, only 1 article had reported a patient suffering from Pott disease after vertebroplasty.


METHODS
A 70-year-old patient with compression fracture of L1 underwent percutaneous kyphoplasty using polymethyl methacrylate.


RESULTS
Two weeks after kyphoplasty, the patient was readmitted with backache and signs of acute infection. Magnetic resonance imaging confirmed the diagnosis of spondylitis with paravertebral abscess formation. A tissue specimen obtained by computed tomography-guided percutaneous biopsy did not yield any pathogen. As broad-spectrum antibiotic therapy failed, combined surgery consisting of posterior instrumentation of Th11-L3 and anterior debridement, corporectomy of L1, and interposition of a titanium mesh cage filled with autologous rib graft was performed. Histologic examination of resected tissue and PCR and culture results confirmed diagnosis of spinal TB. Despite adequate antibiotic treatment and local surgical interventions, the patient died from septic multiple organ failure.


CONCLUSIONS
Indication for kyphoplasty in patients with any history of local or systemic infection should be scrutinized rigorously. Symptoms of spinal TB are often nonspecific, and the clinician should be aware of this entity. Active investigation including microbiological and histologic examination is of utmost importance to avoid any delay in correct diagnosis and specific treatment.
Ivo
Roland
R
Department of Orthopaedic and Trauma Surgery, University of Cologne, Cologne, Germany. roland.ivo@uk-koeln.de
Sobottke
Rolf
R
Seifert
Harald
H
Ortmann
Monika
M
Eysel
Peer
P
D000038:Abscess / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D000368:Aged; D017809:Fatal Outcome; D006801:Humans; D058498:Kyphoplasty / Q000009:adverse effects*; D008159:Lumbar Vertebrae / Q000382:microbiology / Q000473:pathology; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D013166:Spondylitis / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D014399:Tuberculosis, Spinal / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology