The patient is a 20-year-old female patient who was admitted to our hospital 6 weeks after a fall from the 3rd floor of a building; she landed on her feet and subsequently fell on her back. She experienced immediate upper back pain but was ambulating for the next 3 days, and then she developed weakness of the lower limbs, initially most prominent on the right side. A tuberculous (TB) spondylitis was suspected after computed tomography (CT) and magnetic resonance imaging [Figure 1] showed collapsed Th2 and Th3 vertebrae and compression of the spinal cord with associated paravertebral processes. Consequently, she received anti-TB medication and prednisolone for the next 4 weeks in another hospital, however with no clinical improvement. To the contrary, she also developed decreased sensation below the chest and numbness that later developed into dysesthesia. She was still continent to urine and feces. The weakness progressively worsened and developed into a bilateral total paraparesis.
On admission to our hospital, she had complete loss of power and muscular tone in the legs, with the exception of some rotation in the right hip joint, with exaggerated reflexes. In addition, she had decreased sensation to pain and temperature in both legs.
Still under the presumption that she had a TB spondylitis, she was operated via a left cervical incision (the left side is preferred to reduce the chance of recurrent laryngeal nerve injury). The mass was approached, and three level thoracic discectomy (Th1-Th2, Th2-Th3 and Th3-Th4) and two level corpectomy (T2 and T3) were performed. Large iliac bone grafts were taken and grafted along with anterior fixation. Postoperatively, the patient was stable, but there was no immediate change in her clinical condition with regard to power and sensation. She developed a wound leak with discharge of ingested matter, indicating an esophageal fistula. A tear in the posterior esophagus could be identified, and she was reoperated. A nasogastric tube was inserted under direct vision, and the wound was repaired without complications. The biopsy specimen revealed hydatidosis of the spine.
Postoperatively, the patient stayed in hospital for 3 weeks with nutritional and rehabilitation care. At follow-up nearly 4 months after surgery, she had regained muscular strength completely in her lower limbs, thus she walked without support. Postoperative X-ray and CT imaging at 3 months [Figures 2 and 3] showed an acceptable graft alignment with screws and plate in place.