Pedro Karlo M, Torio John Emmanuel R, Rivera Jonathan P, Sih Ibet Marie Y
Division of Neurosurgery, Department of Neurosciences, and.
Department of Pathology, University of the Philippines-Philippine General Hospital, Manila, Philippines; and.
J Neurosurg Case Lessons. 2021 Apr 12;1(15):CASE20144. doi: 10.3171/CASE20144.
Spinal tuberculosis may present in atypical form to involve only the posterior spinal element with relative sparing of the anterior vertebral body and intervertebral disc. Recognition of this unusual pattern is important to avoid delay in diagnosis and treatment.
The authors report a case of a 59-year-old woman with right-sided radiculopathy and motor weakness. Her lumbosacral magnetic resonance imaging showed a large heterogeneous cyst arising from the right L4-5 facet joint. Laminectomy with excision of the cyst was performed. During surgery, the cyst contained cheese-like material that, on histopathological examination, revealed focal aggregates of tuberculous granuloma. Postoperatively, the patient recovered remarkably with no interval development of instability or any deformity.
Facet cyst tuberculosis is rare but should be considered in the differential diagnosis in patients coming from endemic regions. Laminectomy with excision of the cyst along with concurrent antitubercular chemotherapy is a safe and durable treatment option in this case.
脊柱结核可能以非典型形式出现，仅累及脊柱后部结构，而椎体前部和椎间盘相对较少受累。认识到这种不寻常的模式对于避免诊断和治疗的延迟很重要。
作者报告了一例59岁女性，患有右侧神经根病和运动无力。她的腰骶部磁共振成像显示一个巨大的异质性囊肿，起源于右侧L4-5小关节。进行了椎板切除术并切除囊肿。手术中，囊肿内含有奶酪样物质，经组织病理学检查，发现有结核性肉芽肿的局灶性聚集。术后患者恢复良好，未出现不稳定或任何畸形的进展。
小关节囊肿性结核很少见，但对于来自流行地区的患者，在鉴别诊断时应予以考虑。在这种情况下，椎板切除术联合囊肿切除以及同时进行抗结核化疗是一种安全且持久的治疗选择。
