A 43 years old woman had suffered from a lower back pain for 2 months. She experienced pain aggravation after spinal manipulative therapy that was practiced by non-licentiate. Physical examination showed tenderness on L1 and L2 spinous processes. Radionuclide bone scan with 99mTc-MDP showed increased radioactivity of L1, L2 vertebral bodies. The MRI finding showed low signal intensity of L1 and L2 vertebral bodies in T1-weighted image and high signal intensity in T2-weighted image. Needle biopsy finding showed fibrosis and inflammatory cell invasion of bone marrow. We concluded that she had tuberculous spondylitis and non-detection or negligent treatment of a preexisting disease contributed to aggravation of her symptoms.

We report one case of tuberculous spondylitis aggravated by spinal manipulative therapy with review of literatures

Tuberculous spondylitis occurs commonly by the hematogenous spread of infectious organism, Mycobacterium tuberculosis, from the primary foci of the pulmonary and genitourinary systems. Spinal involvement is the most common among tuberculosis of the musculoskeletal system. Tuberculous spondylitis is not easily diagnosed in its early stages and furthermore it is hard to know whether or not the vertebrae are involved by simple X-ray study. The incidence of neurologic deficits varies from 4 to 50%. If the disease is not diagnosed and treated promptly, paraplegia may occur from vertebral collapse. A retrospective study was performed to evaluate the clinical features of tuberculous spondylitis in 51 patients (male 25, female 26), age range of 4-79 years (mean, 36.2⁑18.7). Clinical symptoms, signs, radiological findings and laboratory findings were reviewed. The latest follow ups were done with telephone interviews to evaluate their general improvement and neurological recoveries.

Back pain was the most frequent symptom, followed by sensory disturbance and gait difficulty. Twenty one patients had kyphotic deformity, 7 had lower extremity paralysis, and 29 patients were accompanied by pulmonary tuberculosis. The involved spinal segments were C2 through S1 with the most common site of thoracolumbar spines. The average erythrocyte sedimentation rate (ESR) was 42.1⁑23.5 mm/hour before medical or surgical treatment and 19.6⁑12.6 mm/hour after treatment. The acid-fast bacillus test was positive in only 6 patients. Electrodiagnostic studies and bone scans showed positive findings in 75% and 86%, respectively. Back pain was relieved in 90% of the patients with medical or surgical treatment. In patients with paralysis, initial kyphotic angle and degree of vertebral body loss were significantly greater than in patient without paralysis. When treated surgically early after the leg paralysis, patients with paralysis improved their neurologic deficits and gait better than when treated after 2 months.