A Rarely Occurring Spinal Fracture Precipitated by Generalized Spasms of Tetanus Patient with Spondylitis Tuberculosis

Background: The occurrence of spinal fracture due to tetanus nowadays is extremely rare, as compared to the 1950s, since the widely available anti-tetanus and antispasmodic therapy. The spinal fracture in tetanus patients is usually reported in higher thoracic vertebrae, previously with a rate as hi...

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Bibliographic Details
Published in:International medical case reports journal 2022-10, Vol.15, p.599-603
Main Authors: Huda, Fathul, Ong, Paulus Anam, Wibisono, Yusuf, Dian, Sofiati, Ganiem, Ahmad Rizal
Format: Article
Language:English
Subjects:
Abdomen
Abscesses
Back surgery
Care and treatment
Case Report
Case reports
Comparative analysis
Dental caries
Electrocardiography
Emergency medical care
Fractures
Health aspects
Hospitalization
infection
Infections
Magnetic resonance imaging
medulla spinalis
Ostomy
paraparesis inferior
Spinal cord
spinal fracture
Spondylitis
spondylitis tuberculosis
Tetanus
Tetanus antitoxin
Tuberculosis
Vertebrae
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Summary:Background: The occurrence of spinal fracture due to tetanus nowadays is extremely rare, as compared to the 1950s, since the widely available anti-tetanus and antispasmodic therapy. The spinal fracture in tetanus patients is usually reported in higher thoracic vertebrae, previously with a rate as high as 57.5%. Spondylitis is the most common form of skeletal tuberculosis (TB) and can cause a spinal fracture. In Indonesia, tetanus is still reported, while tuberculosis is still endemic; however, co-infection of both diseases is rarely reported. Case Presentation: A 36-year-old male was brought to our hospital with jaw stiffness, accompanied by fever. A history of dental cavities was present, and 5 days prior, he experienced a fishing hook wound on his right index finger. There was no history of TB. Physical examination showed meningismus, 2 cm trismus, abdominal spasm, opisthotonus, and spontaneous muscle spasms, without dysautonomia. In the third week of hospitalization, while his tetanus condition improved, he complained of weakness in both legs. A thorough history taking revealed a history of backache for 3 years. A wedge-shaped fracture on his 11th and 12th thoracic vertebrae was observed on radiographic examination. A spinal TB diagnosis was made, and treatment was started. He refused to get spinal surgery, then went home with 4 out of 5 motor strength scale. After three months, he returned to his routine activity as a food hawker with no motor deficits. Conclusion: Tetanus spinal fracture is extremely rare nowadays; a thorough history of spinal problems/medication is compulsory for anticipation. This patient's spinal fracture was deemed due to a preexisting TB spinal infection that was precipitated by prolonged continuous tetanic spasm due to general tetanus. Keywords: infection, medulla spinalis, paraparesis inferior, spinal fracture, spondylitis tuberculosis, tetanus
ISSN:1179-142X
1179-142X
DOI:10.2147/IMCRJ.S367615