Isolated tuberculosis of the lumbar apophyseal joint

Background contextPosterior 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.PurposeThe 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 designThe study design was a case report.MethodsA 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.ResultsThe patient was completely relieved of symptoms after instrumented fusion along with antitubercular medication.ConclusionIsolated 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.