Muhammad Ali Chaudhary, Muhammad Ali, Muhammad Asghar, Khawaja Khurshid Ahmad, M A Jawed Siddiqui.
Tuberculosis of Spine Presenting as an Abscess Communicating with the Spinal Canal. An Unusual Manifestation.
Ann King Edward Med Uni Jan ;8(1):57-8.

Tuberculosis of spine is still very common in our country. The spinal involvement consists of a destructive bony lesion involving the center of a vertebral body, anterior margin of the vertebral body or the vertebral end plate with loss of disc space. There may be an associated paraspinal mass due to abscess formation but the communication of this abscess with spinal canal is rare and this abscess may tract to the skin surface with a sinus tract.

Case Report: The present case is of a young man aged 24 years who had an injury to his back five months ago and later developed a tender swelling on the back, which started discharging through a sinus opening. This was diagnosed as an abscess and incision and drainage was done by the surgeon. The swelling reappeared 2 weeks later and again started discharging. At this stage the patient came to Mayo Hospital Lahore where he was investigated. The blood picture showed ESR of 32. Montoux was 15mm, Lymphos were 55%, Polys were 40%. Plain X-ray of Dorsolumbar spine showed loss of bone density of D12 with some thinning of end plates of D12 and L1, with loss of intervertebral disc space. In view of a discharging sinus a sinogram was done which showed an irregular sinus tract extending from the skin surface and communicating with the spinal canal at D12–L1, level. To further evaluate the extent of the fistula a CT scan of spine at D12-L1, level was carried out and axial scans showed that the contrast injected through the sinus opening entered the spinal canal from left lateral aspect but not communicating with the sub arachnoid space. CT scan also showed destruction of D12-L, with loss of disc space and an associated soft tissue paraspinal mass which was an abscess. The appearances are those of a Chronic inflammatory lesion which is most likely tuberculous.

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