A 23-year-old male presented with a one-year history of thoracic back pain as main complaint. At the age of sixteen patient’s spine was injured as a result of falling from 2nd floor. The patient did not consult any doctors. He visited his primary care physician after the aggravation of the pain syndrome.
An X-ray exam revealed destructive changes in the vertebral bodies. CT scans showed following destructive changes of Th9 to Th11 vertebral bodies: height’s reduction of the Th9 vertebral body for more than 50%, subtotal destruction of Th10 vertebral body, height’s reduction of Th11 vertebral body for more than 75%. Collapse of the aforementioned bodies has led to a formation of local kyphosis (Figure 1).
The area of disk destruction contains bone fragments with expansion into and narrowing spinal canal. Expanding paravertebral soft-tissue contains bone fragments and numerous flecks of calcification (Figure 2).
MRI was contraindicatory for the patient due to cochlear implant.
Spinal tuberculosis was confirmed by the identifying Mycobacterium tuberculosis (MBT) with PCR in the tissue sample obtained during a biopsy of the thoracic spine at the lesion level. Additional chest X-ray and bacteriological examination of the sputum revealed manifestation of pulmonary tuberculosis. A chest x-ray showed a consolidation zone in the lower lobe of the right lung (Figure 3).
According to the World Health Organization (WHO), the prevalence of extrapulmonary TB accounts for 8 to 24% of all cases of TB with HIV infection [1]. The most common site of extrapulmonary TB involvement is skeletal TB, a spine in particular (Pott disease). The risk factors of extrapulmonary tuberculosis are an intercurrent disease, including primary or secondary immunodeficiencies (e.g., diabetes mellitus, viral hepatitis, HIV infection, etc.), but the process can also develop without the patient's previous comorbidities [2].
The diagnosis of skeletal TB and spinal TB in particular (Pott's disease) is difficult due to lack of specific clinical symptoms, and its late manifestation. According to the long-time single-centre study included 348 patients with tuberculosis spondylitis, only 68% of them had different neurological/motor disorders without any correlation to the severity of spinal lesions [3]. Similar data were provided by other studies [4]. Medical imaging should be used for early diagnosis and determination of degree of the process.
Insidious clinical picture of TB spondylodiscitis is leading to delay in diagnosis. Sole back-pain complaints do not receive proper attention quite often.
The typical form of spinal manifestation of tuberculosis consists of adjacent vertebral bodies’ destruction along with the intervertebral disc, paravertebral or a psoas abscess formation [3].
Magnetic resonance imaging (MRI) is the diagnostic method of choice for lumbar spinal pathology identification. In some situations, if an MRI is not possible to perform, CT could also be used to show typical signs of Pott's disease.
The final diagnosis is based on clinical, radiological, laboratory, microbiological and histopathological data. Clinicians should aware of possibility of such infections to improve patient outcomes.
Treatment of extrapulmonary TB has similar treatment regimens as for pulmonary TB. The same antibiotic regimens are recommended, with increased duration of the course if it necessary [5].
Pott Disease (Tuberculous [TB] Spondylitis)
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Based on the provided chest X-ray and thoracic spine CT images, the following can be observed:
1. Several thoracic vertebrae (visible in the mid to lower segments) show local bony destruction and uneven sclerosis, with irregular destructive changes at the vertebral edges;
2. The intervertebral space (between the suspected diseased vertebrae) is narrowed, indicating disc involvement;
3. Soft tissue swelling or areas of low density are observed around some vertebrae, possibly suggesting paravertebral or prevertebral abscess formation;
4. Chest frontal and lateral X-rays show generally acceptable transparency of the lung fields, with no significant active pulmonary lesions. No explicit abnormal findings in the cardiophrenic angle or hilum; however, the lateral view of the spine indicates localized morphological changes in the vertebrae.
Considering the patient's persistent back pain history, imaging findings, lack of timely consultation following previous trauma, and the characteristic features of tuberculous vertebral destruction, the most likely diagnosis is: "Tuberculous Spondylitis (Pott’s Disease)".
For definitive confirmation, pathological biopsy, microbiological culture (acid-fast bacilli culture or PCR test), and comprehensive tuberculosis screening (e.g., chest CT, sputum culture, IGRA test, etc.) may be performed.
Since spinal tuberculosis often involves vertebral structural damage and inflammation, rehabilitation must be gradual and individualized to prevent exacerbating spinal load or causing fractures/deformities. Below is a simplified FITT-VP principle:
Throughout rehabilitation, closely monitor back pain, range of motion, and neurological signs. If severe pain worsens or new neurological deficits appear, seek medical evaluation promptly. Also ensure correct wearing of protective braces or supports (if recommended) to enhance safety during exercises.
This report provides a reference analysis based on current imaging and basic history only. It is not a substitute for an in-person consultation or specialized medical advice. Diagnosis and treatment decisions must be based on comprehensive specialist evaluation. Please consult a healthcare professional if you have any concerns.
Pott Disease (Tuberculous [TB] Spondylitis)
