Dean Anudariya, Zyck Stephanie, Toshkezi Gentian, Galgano Michael, Marawar Satya
Neurosurgery, State University of New York Upstate Medical University, Syracuse, USA.
Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, USA.
Cureus. 2019 Jan 8;11(1):e3855. doi: 10.7759/cureus.3855.
Though uncommon in developed countries, spinal tuberculosis must still be considered in patients with a suspicious clinical history, to avoid delays in treatment. This case series highlights the special considerations that need to be taken into account while tackling the diagnostic and therapeutic challenges associated with this disease. We present two interesting cases of spinal tuberculosis. The first case was a 26-year-old female who presented with chronic back pain and an initial misdiagnosis of ankylosing spondylitis. The second case was a 26-year-old male with new lower extremity weakness, numbness, and urinary retention. Both cases had clear indications for surgery, however, the first case was treated with medical management upon patient request. The patient was managed non-surgically and improved clinically though she may need surgery in the future. The second case was treated with emergency surgery and the patient regained full neurologic function at follow-up. These cases demonstrate the importance of considering spinal tuberculosis in the differential diagnosis of high-risk patients as well as individualizing treatment strategies for each patient.
虽然在发达国家脊柱结核并不常见，但对于有可疑临床病史的患者仍必须考虑到该病，以避免治疗延误。本病例系列突出了在应对与该疾病相关的诊断和治疗挑战时需要考虑的特殊因素。我们呈现两例有趣的脊柱结核病例。第一例是一名26岁女性，表现为慢性背痛，最初被误诊为强直性脊柱炎。第二例是一名26岁男性，出现新的下肢无力、麻木和尿潴留。两例均有明确的手术指征，然而，第一例根据患者要求接受了药物治疗。该患者接受了非手术治疗，临床症状有所改善，不过未来可能仍需手术。第二例接受了急诊手术，随访时患者神经功能完全恢复。这些病例表明，在高危患者的鉴别诊断中考虑脊柱结核以及为每位患者制定个体化治疗策略的重要性。
