A 28-year-old female presented to Fatmawati Hospital, Jakarta, Indonesia due to progressive tetraparesis accounting for seven months. Initially there was mild neck pain, and then she experienced numbness along with weakness of all four extremities. The symptoms were gradually worsened such that at the time of admission, she could not walk.
A series of radiographic and CT scan depicted multiple vertebral body destruction anteriorly, along with facet joint dislocation and mild retrolisthesis of C4-C5 segments (Figs. 1, 2). MR images of the cervical region was demonstrated pathologic contrast enhancement on C4 to T7 vertebrae, a total of fourteen contiguous segments, with spinal canal stenosis on the level of C4 to T4 and bilateral anterolateral paravertebral soft tissue abscess at the level of C4 to T9 (Fig. 3). Those findings were highly typical of spinal tuberculosis.
The patient was administered anti-tuberculous agents for two months before undergoing one-staged posterior-only debridement, decompression, and instrumentation. Postoperative radiographs demonstrated that the kyphosis was obviously improved (Fig. 4). After the surgery, the patient was put on a cervicothoracic brace. The patient was closely followed up, and after 12 months postoperatively, she regained neurological recovery with only mild residual neck pain. The patient demonstrated a satisfying level of functional improvement as recorded by the Neck Disability Index (NDI) and SF-36 scores of 4/100 and 94%, respectively.
Bony bridge on CT images was discovered at 18 months of follow-up, along with the normal value of erythrocyte sedimentation rate and C-reactive protein; it was the time we discontinued the anti-tuberculous therapy.