Spinal TB is a common disease in thedeveloping countries 6,7. Dorsolumbar spine is the common place of TB Spineand the incidence on this place is about 95% and incidence on the cervicalspine is 5%.8 Sacral spine TB israre and large series has not been reported in the literature. The diagnosis ofthe sacral spine TB is challenging for physicians, radiologists and spinesurgeons. Clinical assessment of the patients should start with a careful historyand a detailed physical examination.
The clinical presentation can vary accordingto the age, health status, site of infection, stage of the disease and theabsence or presence of abscesses, sinus tracts or neurological status. 9 The common presenting symptoms of the sacralTB are non-speci?c pain and swelling. Sometime, the skeletal tuberculosisfrequently mimics neoplasia like chordoma and osteoclastoma leading toincorrect initial diagnosis and delay in the institution of treatment.
10 CT andMagnetic Resonance Imaging (MRI) scans are the choice of radiologicalinvestigation. CT can reveal destructive lesions in the sacrum and the sacrumcortex may be diffusely destroyed secondary to the lesion expansion. And theMRI of the sacrum usually has a severe replacement of bone marrow, presentingwith a low signal intensity mass on T1-weighted images patients and onT2-weighted images on spin echo sequences .
11 In this case, thepatient presented with low back pain (LBP) and aspiration confirmed the cold abscess.The CT scan suggested the TB and the CT guided biopsy of the lesion proved thesacral spine TB. The patient wasreferred to the TB clinic for ATT. After 18 months of ATT the repeat CT of thesacral spine showed the healed lesion. The general condition of the patientsalso improved a lot.
The sacral spine TB was managed successfully. Other literature also showed diagnosis bybiopsy and successful treatment of the sacral spine TB with ATT. 3,4,5,12 Isolated sacral tuberculosis is rarebut high degree of suspicion is needed in the presence of atypical clinicalsymptoms like LBP, gluteal region swelling and patient suffering from DM.