Senile thoracolumbar tuberculosis with kyphosis and severe osteoporosis treated with polymethylmethacrylate-augmented screw fixation

Background Elderly osteoporotic patients with kyphosis secondary to spinal tuberculosis (TB) are at high risk for implant failure. For these patients, polymethylmethacrylate (PMMA)-augmented pedicle screw fixation provides immediate stability but increases the risk of infection. Here, we evaluated the outcome for a 78-year-old osteoporotic female with TB-related kyphosis successfully managed with PMMA-augmented pedicle screw fusion. Case description A 78-year-old female presented with mid-back pain, progressive kyphotic deformity, and increasing paraparesis. The magnetic resonance imaging revealed infectious T12-L1 spondylitis with accompanying vertebral body destruction/kyphosis. She underwent a single-stage posterior PMMA-augmented screw fixation from T9-L4 supplemented with anterior reconstruction and cage/bone grafting. The histology/cultures were consistent with spinal TB for which she received anti-tuberculosis therapy, followed by once weekly teriparatide (60 µg for 6 weeks). Neurological recovery was complete within 3 months, and by 2 years, the imaging confirmed a stable fusion. Conclusion A 78-year-old osteoporotic female with T12/L1 TB-related spondylitis successfully underwent selective PMMA-augmented pedicle screw fixation from T9-L4 supplemented with anti-tubercular therapy.