Case Report: Diagnostic and therapeutic challenges of secondary spinal tuberculosis following percutaneous vertebroplasty: a case of staged surgery with bone cement retention report.

BACKGROUND: The incidence of secondary infectious complications following percutaneous vertebroplasty is less than 1%. Among these complications, tuberculous spondylitis is particularly rare, with only a few cases reported in the literature since this condition is usually caused by the hematogenous spread of a pre-existing latent Mycobacterium tuberculosis infection rather than by direct intraoperative contamination. Misdiagnosis and improper treatment of such a condition may lead to catastrophic consequences including infection dissemination, nerve damage, and progressive kyphotic deformity. CASE REPORT: This report describes a 76-year-old male patient who underwent percutaneous vertebroplasty for a T11 vertebral fracture at a local hospital one month earlier. After admission, imaging examinations and needle biopsy confirmed the diagnosis of spinal tuberculosis. Given the patient's rapidly progressive condition and risk of incomplete paraplegia, we adopted a staged surgical strategy: first, emergency posterior laminectomy with decompression and lesion debridement was performed to relieve neural compression and control infection, which preserved the previously injected vertebral bone cement. Once the infection was controlled and stabilized, a second-stage procedure with pedicle screw internal fixation was performed to restore spinal stability. This staged approach with bone cement retention has not been previously reported in the literature. Postoperatively, the patient showed significant improvement in bilateral lower limb numbness and muscle strength, and achieved functional mobility with thoracolumbar brace support. At the 12-month follow-up, the patient was able to walk independently with no recurrence of low back pain, and no complications such as tuberculosis recurrence or internal fixation loosening were detected. CONCLUSION: This case report documents a rare case of postoperative tuberculous spondylitis following percutaneous vertebroplasty, which was successfully managed with a unique staged surgical approach featuring bone cement retention. This strategy effectively balanced infection control and spinal stability, ultimately achieving favorable clinical outcomes and providing a novel therapeutic reference for the management of such complex complications.