Cervical spinal tuberculosis

Cervical spinal tuberculosis is a rare variant of extra-pulmonary tuberculosis. We present the case of Vietnamese woman, aged 48, who was admitted to the Department of Neurosurgery because of a cervical spine (C7) compression fracture. Several months earlier, the patient complained of neck pain and numbness of the hands. On physical examination, the woman was subfebrile and complained of pain over the cervical spinal area. Neurological examination revealed no focal motor weakness. The roentgenograms of chest, pelvis and cranium were without patholo gical changes. Abdominal ultrasonography was normal. Radioisotope bone-scanning showed abnormal accumulation of isotope in the lower cervical region, thoracic vertebra, as well as in the articulations of knees and shoulders and in the left tibial bone. An MRI scan revealed compression fracture of the C7 vertebral body with infiltration of paraspinal tissues at the vertebral column with indentation of osseous masses into the spinal canal. The lesion resembled neoplasm metastasis. The neoplasm infiltrating vertebral body C7, two discs, C6-C7 and C7-Th1, and ligament were removed surgically. Neuropathological examination of the removed material showed typical granulomatous inflammation with characteristic infiltrate of lymphocytes, epithelioid macrophages and Langhans-type multi nucleated giant cells. The spoligotyping method confirmed the presence of Mycobacterium tuberculosis complex in the specimens.