Isolated tuberculosis of the lumbar apophyseal joint.

BACKGROUND CONTEXT: Posterior element tuberculosis is rare accounting for only 3% to 5% of all spinal tuberculosis. To our knowledge, no case of isolated facet joint tuberculosis with coronal decompensation has been reported in literature so far.

PURPOSE: The purpose of this study was to describe a case of tuberculous arthritis of the lumbar facet joint and its effect on coronal balance of the spine.

STUDY

DESIGN

The study design was a case report.

METHODS

A 14-year-old boy presented with a 3-month history of back pain without radiation and with normal neurological findings. Computed tomography and magnetic resonance imaging showed destruction of the right L4-L5 facet joint with L5-S1 spondylolytic listhesis. Despite 2 months of antitubercular medication after a core biopsy confirmation of L4-L5 facet tuberculosis, there was progression of coronal decompensation of the spine with severe pain. Instrumentation with intertransverse fusion was done as a secondary procedure.

RESULTS

The patient was completely relieved of symptoms after instrumented fusion along with antitubercular medication.

CONCLUSION

Isolated lumbar facet joint tuberculosis is a rare entity with a potential for coronal decompensation of the spine, which makes early instrumented fusion with antitubercular medication a viable treatment modality.