Isolated Tuberculosis of Spinous Process of C5 Vertebra: A Rare Case Report of Reformation of Destroyed Spinous Process

INTRODUCTION: Tuberculosis of posterior spinal elements or neural arch tuberculosis is a rare clinical entity. We report a patient with isolated tuberculosis of the C5 spinous process and reformation of destroyed spinous process in response to antitubercular therapy (ATT). This is first case report of the kind to the best of our knowledge. CASE REPORT: A young male aged 22 years presented to us with a slow-growing, painful lump for the past 3 months accompanied by a discharging sinus at the back of his neck. Plain radiograph and computed tomography scan showed destruction of the C5 spinous process. Magnetic resonance imaging cervical spine showed presence of abscess in addition to the above finding. The patient underwent incision and drainage of abscess followed by local injection of streptomycin. CB-NAAT (Gene Xpert) and histopathological examination confirmed the diagnosis of tuberculosis. The patient responded to ATT very well. The C5 spinous process which was destroyed by the disease process was seen to have gradually reformed on serial radiographs. CONCLUSION: Isolated posterior spinal tuberculosis is rare, but it must be thought of as a differential diagnosis in suitable cases. Diseased tissue in tuberculosis has high healing potential in response to medical therapy, thus avoiding the need of radical debridement.