Isolated tuberculosis of the lumbar apophyseal joint

Abstract 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.