A 22-years-old Male presented with chief complaint of weakness on both lower limbs for 6 months prior to admission. The weakness also came along with back pain. There was no previous history of trauma or fever. There was history of night sweat and decrease of body height. Patient then went to nearest hospital, underwent x-ray examination, and was told that there was a spondylitis TB. Patient got anti TB drugs for 2 months, and after that the weakness improved. Patient was able to walk, but the back pain persisted. Patient was then referred to our hospital for further treatment. There was no disturbance in micturition and defecation. There were no other families with the same condition as the patient.
From physical examination we could not find any abnormality. Muscle power for both lower limbs were +4. The timeline of patient's clinical course is shown in Table 1.
The results of X-ray examination were loss of lumbar lordosis, decrease of body height at L5, burst fracture of L5, end plate sclerosis at level L4-L5 and L5-S1, decrease intervertebral body height at L4-L5 and L5-S1, and fusiform soft tissue opacity around vertebrae L4-S1 (Fig. 1). The findings of MRI examination of the lower vertebrae were loss of lumbar lordosis, decrease of body height at L5, decrease intervertebral body height at L4-L5 and L5-S1, protrusion of L4-L5 intervertebral disc into the spinal cord, and paraspinal abscess (Figs. 2 and 3). The local kyphotic angle is 21.1  and regional kyphotic angle is 15.7 .
The patient was diagnosed by paraparesis due to spondylitis Tb of L4-S1 with paravertebral abscess at L4-S1 Frankle D then underwent anterior debridement and fusion (Fig. 4). Patient was given two months of intensive four-drug therapy, including isoniazid (H), rifampicin (R), ethambutol (E), and pyrazinamide (Z), followed by two drugs (RH) therapy for a continuation phase of 4 months.
Patient was followed up physically and radiographically at one, three, six months, and one year after the surgery. Postoperative radiograph showed restoration of vertebral height and visible expendable mesh (Fig. 5).
Three months and six months and one year post operative follow up showed good functional outcome and sign of fusion from x ray (Fig. 6) and CT (Fig. 7). This kind of procedure is currently rare procedure without clear comparison between conventional pedicle screw and rod system for corpus destruction of lumbal spondylitis tuberculosis with anterior debridement and fusion using expendable mesh cage. However, we hope this case report will provide further evaluation and long-term larger follow up study (cohort study) for another kind of spondylitis tb procedure as an alternative treatment despite better or worse for selective patient.