Surgical Treatment for Spinal Tuberculosis without Elevation of Inflammatory Biomarkers at the Initial Visit Mimicking Spinal Metastasis
Here, we report a case of spinal tuberculosis without elevation of C-reactive protein (CRP) at the initial visit mimicking spinal metastasis. A 70-year-old woman developed progressive paraplegia without a history of injury and came to our hospital for evaluation. Severe compression to the spinal cor...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Case Reports in Orthopedics |
| Online Access: | http://dx.doi.org/10.1155/2020/8873170 |
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| author | Takuya Sakamoto Hiroshi Takahashi Junya Saito Yasuo Matsuzawa Yasuchika Aoki Arata Nakajima Masato Sonobe Yorikazu Akatsu Manabu Yamada Yuki Akiyama Tatsunori Iwai Keita Yanagisawa Yasuhiro Shiga Kazuhide Inage Sumihisa Orita Yawara Eguchi Satoshi Maki Takeo Furuya Tsutomu Akazawa Masao Koda Masashi Yamazaki Seiji Ohtori Koichi Nakagawa |
| author_facet | Takuya Sakamoto Hiroshi Takahashi Junya Saito Yasuo Matsuzawa Yasuchika Aoki Arata Nakajima Masato Sonobe Yorikazu Akatsu Manabu Yamada Yuki Akiyama Tatsunori Iwai Keita Yanagisawa Yasuhiro Shiga Kazuhide Inage Sumihisa Orita Yawara Eguchi Satoshi Maki Takeo Furuya Tsutomu Akazawa Masao Koda Masashi Yamazaki Seiji Ohtori Koichi Nakagawa |
| author_sort | Takuya Sakamoto |
| collection | DOAJ |
| description | Here, we report a case of spinal tuberculosis without elevation of C-reactive protein (CRP) at the initial visit mimicking spinal metastasis. A 70-year-old woman developed progressive paraplegia without a history of injury and came to our hospital for evaluation. Severe compression to the spinal cord with osteolytic destruction of the spinal vertebrae at T6-7 was observed without elevation of CRP. A T4-9 posterior decompression and fusion were performed. Although the pathology revealed no malignant tumor cells, a positron emission tomography-computed tomography (PET-CT) showed upregulation of the thyroid gland and aspiration cytology revealed a thyroid carcinoma. Thus, we diagnosed her with spinal metastases from thyroid carcinoma. Conservative treatment was chosen with the hope of a significant neurologic recovery; however, 9 months after the primary surgery, she returned to our hospital with reprogressive paraplegia. In addition to progression of osteolytic changes to the T5-7 vertebrae, a coin lesion on the right side of the lung and elevation of CRP were observed. Finally, we diagnosed her with spinal tuberculosis based on the results of a CT-guided needle culture. Two-stage surgeries (posterior and anterior) were performed in addition to administering antituberculosis medications. At the 1-year postoperative follow-up evaluation, both neurologic function and laboratory data were improved with T5-9 complete fusion. It is difficult to determine based on imaging findings alone whether osteolytic vertebrae represent spinal metastases or tuberculosis. Even though inflammatory biomarkers, such as CRP, were not elevated, we should consider the possibility of not only spinal metastases but also tuberculosis when planning surgery involving osteolytic vertebrae. In addition, the combination of neurological, imaging, and pathological findings is important for the diagnosis of spinal tuberculosis. |
| format | Article |
| id | doaj-art-7447f288dc5a40c08846f4de14550e84 |
| institution | Kabale University |
| issn | 2090-6749 2090-6757 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Orthopedics |
| spelling | doaj-art-7447f288dc5a40c08846f4de14550e842025-02-03T01:00:30ZengWileyCase Reports in Orthopedics2090-67492090-67572020-01-01202010.1155/2020/88731708873170Surgical Treatment for Spinal Tuberculosis without Elevation of Inflammatory Biomarkers at the Initial Visit Mimicking Spinal MetastasisTakuya Sakamoto0Hiroshi Takahashi1Junya Saito2Yasuo Matsuzawa3Yasuchika Aoki4Arata Nakajima5Masato Sonobe6Yorikazu Akatsu7Manabu Yamada8Yuki Akiyama9Tatsunori Iwai10Keita Yanagisawa11Yasuhiro Shiga12Kazuhide Inage13Sumihisa Orita14Yawara Eguchi15Satoshi Maki16Takeo Furuya17Tsutomu Akazawa18Masao Koda19Masashi Yamazaki20Seiji Ohtori21Koichi Nakagawa22Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741, JapanDepartment of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741, JapanDepartment of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741, JapanDepartment of Internal Medicine, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741, JapanDepartment of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2, Okayamadai, Togane City, Chiba 283-8686, JapanDepartment of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741, JapanDepartment of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741, JapanDepartment of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741, JapanDepartment of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741, JapanDepartment of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741, JapanDepartment of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741, JapanDepartment of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741, JapanDepartment of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuoku, Chiba City, Chiba 260-8677, JapanDepartment of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuoku, Chiba City, Chiba 260-8677, JapanDepartment of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuoku, Chiba City, Chiba 260-8677, JapanDepartment of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuoku, Chiba City, Chiba 260-8677, JapanDepartment of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuoku, Chiba City, Chiba 260-8677, JapanDepartment of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuoku, Chiba City, Chiba 260-8677, JapanDepartment of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki City, Kanagawa 216-8511, JapanDepartment of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba City, Ibaraki 305-8575, JapanDepartment of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba City, Ibaraki 305-8575, JapanDepartment of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuoku, Chiba City, Chiba 260-8677, JapanDepartment of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741, JapanHere, we report a case of spinal tuberculosis without elevation of C-reactive protein (CRP) at the initial visit mimicking spinal metastasis. A 70-year-old woman developed progressive paraplegia without a history of injury and came to our hospital for evaluation. Severe compression to the spinal cord with osteolytic destruction of the spinal vertebrae at T6-7 was observed without elevation of CRP. A T4-9 posterior decompression and fusion were performed. Although the pathology revealed no malignant tumor cells, a positron emission tomography-computed tomography (PET-CT) showed upregulation of the thyroid gland and aspiration cytology revealed a thyroid carcinoma. Thus, we diagnosed her with spinal metastases from thyroid carcinoma. Conservative treatment was chosen with the hope of a significant neurologic recovery; however, 9 months after the primary surgery, she returned to our hospital with reprogressive paraplegia. In addition to progression of osteolytic changes to the T5-7 vertebrae, a coin lesion on the right side of the lung and elevation of CRP were observed. Finally, we diagnosed her with spinal tuberculosis based on the results of a CT-guided needle culture. Two-stage surgeries (posterior and anterior) were performed in addition to administering antituberculosis medications. At the 1-year postoperative follow-up evaluation, both neurologic function and laboratory data were improved with T5-9 complete fusion. It is difficult to determine based on imaging findings alone whether osteolytic vertebrae represent spinal metastases or tuberculosis. Even though inflammatory biomarkers, such as CRP, were not elevated, we should consider the possibility of not only spinal metastases but also tuberculosis when planning surgery involving osteolytic vertebrae. In addition, the combination of neurological, imaging, and pathological findings is important for the diagnosis of spinal tuberculosis.http://dx.doi.org/10.1155/2020/8873170 |
| spellingShingle | Takuya Sakamoto Hiroshi Takahashi Junya Saito Yasuo Matsuzawa Yasuchika Aoki Arata Nakajima Masato Sonobe Yorikazu Akatsu Manabu Yamada Yuki Akiyama Tatsunori Iwai Keita Yanagisawa Yasuhiro Shiga Kazuhide Inage Sumihisa Orita Yawara Eguchi Satoshi Maki Takeo Furuya Tsutomu Akazawa Masao Koda Masashi Yamazaki Seiji Ohtori Koichi Nakagawa Surgical Treatment for Spinal Tuberculosis without Elevation of Inflammatory Biomarkers at the Initial Visit Mimicking Spinal Metastasis Case Reports in Orthopedics |
| title | Surgical Treatment for Spinal Tuberculosis without Elevation of Inflammatory Biomarkers at the Initial Visit Mimicking Spinal Metastasis |
| title_full | Surgical Treatment for Spinal Tuberculosis without Elevation of Inflammatory Biomarkers at the Initial Visit Mimicking Spinal Metastasis |
| title_fullStr | Surgical Treatment for Spinal Tuberculosis without Elevation of Inflammatory Biomarkers at the Initial Visit Mimicking Spinal Metastasis |
| title_full_unstemmed | Surgical Treatment for Spinal Tuberculosis without Elevation of Inflammatory Biomarkers at the Initial Visit Mimicking Spinal Metastasis |
| title_short | Surgical Treatment for Spinal Tuberculosis without Elevation of Inflammatory Biomarkers at the Initial Visit Mimicking Spinal Metastasis |
| title_sort | surgical treatment for spinal tuberculosis without elevation of inflammatory biomarkers at the initial visit mimicking spinal metastasis |
| url | http://dx.doi.org/10.1155/2020/8873170 |
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