Sonone S V, Dahapute A A, Keny S A, Marathe N A, Dhole K P
Department of Orthopedics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India.
Department of Orthopedics, Topiwala National Medical College, Mumbai. Maharashtra, India.
J Orthop Case Rep. 2019;9(4):41-43. doi: 10.13107/jocr.2019.v09.i04.1470.
Spinal Koch involving posterior elements of the neural arch is one of the atypical presentations which are often missed.
A 40-year-old female presented with radiculopathy and bilateral lower limb claudication for 5 months. Radiological investigations showed compressive lesion resembling flavum hypertrophy and a degenerative etiology was thus suspected. However, histopathology report pointed toward tuberculosis (TB) of the posterior elements (atypical form). Management with surgical decompression and anti-Koch treatment gave a successful outcome.
TB affecting posterior elements of spine is a rare entity and needs a high degree of suspicion for accurate diagnosis. Newer radiological interventions such as computed tomography and magnetic resonance imaging along with histopathological evidence will help to clinch the diagnosis of Koch's spine early before neurological problems or deformity sets in. Keeping a high index of suspicion will help to avoid missing the atypical forms of the disease.
累及神经弓后部结构的脊柱结核是一种非典型表现，常易被漏诊。
一名40岁女性，出现神经根病和双侧下肢间歇性跛行5个月。影像学检查显示有类似黄韧带肥厚的压迫性病变，因此怀疑为退行性病因。然而，组织病理学报告显示为后部结构结核（非典型形式）。手术减压和抗结核治疗取得了成功。
影响脊柱后部结构的结核是一种罕见疾病，准确诊断需要高度怀疑。计算机断层扫描和磁共振成像等新型影像学检查以及组织病理学证据将有助于在出现神经问题或畸形之前早期确诊脊柱结核。保持高度怀疑指数有助于避免漏诊该疾病的非典型形式。
