Complete Neurological Recovery Following Combined Anterior-Posterior Cervical Corpectomy and Circumferential Stabilization for Severe Cervical Tuberculosis with Grade IV C3-C4 Spondylolisthesis: A Rare Case Report from Somalia.

BACKGROUND

Cervical spinal tuberculosis accompanied by extensive vertebral destruction and high-grade spondylolisthesis is an uncommon but potentially disabling condition. Early surgical management combined with appropriate anti-tuberculous therapy (ATT) is essential to prevent irreversible neurological damage.

CASE PRESENTATION: A 30-year-old male presented with gradually worsening weakness in both upper and lower limbs over one month, associated with sensory disturbance. Neurological assessment demonstrated muscle strength of 2/5 in the upper extremities and 3/5 in the lower extremities. Magnetic resonance imaging (MRI) and computed tomography (CT) revealed advanced cervical tuberculosis characterized by Grade IV C3-C4 spondylolisthesis, dislocation of the left facet joint, spinal instability, epidural abscess formation, and early signs of myelomalacia. Routine laboratory investigations were within normal limits.

MANAGEMENT AND OUTCOME: The patient underwent a combined anterior-posterior cervical surgical procedure. An anterior C4 corpectomy with removal of the infected C3-C4 and C4-C5 intervertebral discs was performed, followed by reconstruction using a corticocancellous iliac crest autograft and stabilization with anterior cervical plating from C3 to C5. Additional posterior stabilization was achieved through lateral mass screw fixation at C3, C4, C5, and C6, providing circumferential spinal support. GeneXpert testing confirmed drug-sensitive Mycobacterium tuberculosis. Postoperative imaging demonstrated satisfactory spinal alignment and adequate neural decompression. Standard ATT was initiated. At one-month follow-up, the patient achieved complete neurological recovery with full motor strength (5/5) and independent functional status.

CONCLUSION

This case illustrates that integrated anterior-posterior circumferential stabilization alongside anti-tuberculous treatment can provide favorable neurological recovery in specific patients with severe cervical tuberculosis and high-grade spondylolisthesis. More extensive investigations are required to ascertain the generalizability of this methodology.