title: S1 tuberculosis treated with segmental lumbopelvic fixation: a case report.
abstract: METHODS
  A case report.
  
  
  OBJECTIVE
  To describe an effective surgical option for sacral tuberculosis (TB).
  
  
  BACKGROUND
  Sacral TB is a rare cause of low back pain. A differential diagnosis of TB should always be made, especially in India where TB cases are on a rampant rise with increasing drug resistance and immunosuppressed population.
  
  
  METHODS
  A retrospective review. RESULTS.: We report on a 24-year-old woman with low back pain and radiculopathy. Magnetic Resonance Imaging (MRI) showed a destructive lesion in S1 body. Empirical antitubercular treatment was started elsewhere with no relief but worsening of the lesion. She underwent a Computed Tomography (CT)-guided biopsy and drug sensitivity test, which did not reveal anything. The patient was bedridden for almost a year. A lumbopelvic instrumented fixation and S1 body reconstruction with structural allograft was performed. Culture sensitivity revealed multidrug resistance. After surgery, the patient responded rapidly, and at 2-year follow-up, she is symptom-free.
  
  
  CONCLUSIONS
  TB should always be considered as a differential diagnosis of sacral lesions, and identifying multidrug resistance is equally important in its treatment. Lumbopelvic fixation is a safe and reliable option as it unloads the S1 segment by achieving fixation in the lumbosacral spine and iliac wings.
authors.affiliation: Department of Orthopaedics, Bombay Hospital, New Wing, Medical Research Centre, Mumbai, Maharashtra, India.
authors.forename: Sambhav P
authors.initials: SP
authors.lastname: Shah
authors.forename: Arvind G
authors.initials: AG
authors.lastname: Kulkarni
mesh_terms: D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000209:etiology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery; D019637:Orthopedic Procedures / Q000379:methods*; D010384:Pelvic Bones / Q000601:surgery; D011843:Radiculopathy / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D012447:Sacrum / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D055815:Young Adult
chemical_list: D000904:Antibiotics, Antitubercular