Kim Jang-Hoon, Kim Se-Hoon, Choi Jong-Il, Lim Dong-Jun
Department of Neurosurgery, Ansan Hospital, Korea University College of Medicine, Seoul, Korea.
Korean J Spine. 2014 Jun;11(2):77-80. doi: 10.14245/kjs.2014.11.2.77. Epub 2014 Jun 30.
Spinal tuberculosis-associated symptoms are not so unique as to immediately indicate the proper diagnosis in most cases. Distinguishing spinal tuberculosis (Pott's disease) from pyogenic spondylitis is often difficult, and lesions metastatic from systemic malignancy are the other major entity from which spinal tuberculosis must be distinguished.
A 27-year-old male patient presented with a history of back pain after a minor trauma 1 month ago. Computed tomography and magnetic resonance imaging of the thoracic spine showed multiple osteolytic bone lesions at the bodies of T9, T10 and T11 vertebrae and the spinous processes of T12 and L1. Other noncontiguous osteolytic lesions were noted at S2 body and right sacro-iliac joint.
To confirm the pathologic diagnosis, the patient underwent an open biopsy for the T12 and L1 spinous process lesions and a percutaneous transpedicular biopsy on T9, T10, T11 lesions. Frozen biopsy was reported as compatible with chronic granulomatous caseating necrosis without malignant cells. The final diagnosis was an atypical presentation of multiple spinal tuberculosis. The patient received an appropriate enteral anti-tuberculosis therapy and recovered without any complications. Follow-up MRI taken after a year of medical treatment revealed marked resolution of the lesions.
Current research indicates the incidence of multi-level noncontiguous, remote vertebral tuberculosis is 1.1% to 16%. Because tuberculous spondylitis could represent variant and atypical pattern, the disease should be considered in differential diagnosis along with other diseases such as metastatic neoplasm, pyogenic spondylitis, especially when the radiologic studies are revealing multiple spinal lesions.
脊柱结核相关症状在大多数情况下并非独特到能立即明确诊断。区分脊柱结核（波特病）与化脓性脊柱炎往往困难，而系统性恶性肿瘤转移所致病变是脊柱结核必须鉴别的另一主要疾病。
一名27岁男性患者，有1个月前轻微外伤后背痛病史。胸椎计算机断层扫描和磁共振成像显示T9、T10和T11椎体以及T12和L1棘突有多个溶骨性骨病变。在S2椎体和右骶髂关节发现其他不连续的溶骨性病变。
为明确病理诊断，患者对T12和L1棘突病变进行了开放活检，对T9、T10、T11病变进行了经皮椎弓根活检。冰冻活检报告为符合慢性肉芽肿性干酪样坏死，无恶性细胞。最终诊断为多发性脊柱结核的非典型表现。患者接受了适当的肠内抗结核治疗，康复且无任何并发症。药物治疗一年后进行的随访磁共振成像显示病变明显消退。
目前研究表明，多节段不连续、远处椎体结核的发生率为1.1%至16%。由于结核性脊柱炎可能表现为变异和非典型模式，在鉴别诊断时应将该疾病与其他疾病如转移性肿瘤、化脓性脊柱炎一并考虑，尤其是当影像学检查显示多个脊柱病变时。
