Spinal Tuberculosis Mimicking Failed Back Surgery

Patient: Female, 59 Final Diagnosis: Spinal tuberculosis Symptoms: Back pain • tiredness • night sweats Medication: — Clinical Procedure: Surgery and medical treatment Specialty: Neurosurgery OBJECTIVE: Challenging differential diagnosis BACKGROUND: The aim of this study was to draw attention to rare spinal infections in recurrent failed spinal surgeries. CASE REPORT: A 59-year-old female was admitted to the hospital for back pain, which was assessed as a 9 on the visual analogue scale (VAS); the patient reported tiredness and night sweats. She had an operation for L3–4 far lateral disc herniation four years ago. Then another operation for L4–5 disc herniation six months ago and immediately three months later she has an operation with L3–4–5 fixation again. She had hypothyroidism, diabetes mellitus, and hypertension. Her daughter was cured of pulmonary tuberculosis 20 years ago. We performed an operation by L4–5 discectomy; all granulation formation with inflammatory processes were debrided and irrigated with antibiotics at levels of L3–5. The old fixation was controlled and replaced. Her back pain improved immediately after surgery; she had a score of 2 on the VAS. Two days after her surgery, our Infection Disease Department reported acid resistant bacillus (ARB+) in samples and began anti-tuberculosis medication. CONCLUSIONS: Spinal infections should always be taken into consideration in recurrent failed back surgeries.