Multifocal Non-contiguous Spinal Tuberculosis: A Report of 3 Surgically-Treated Patients

Introduction: Multifocal non-contiguous spinal tuberculosis (MSTB) is a rare pathology, often described as a manifestation of delayed presentation, neglected illness, or disease in immunocompromised individuals. The non-contiguous spread is attributed to the valveless nature of venous drainage to the spinal column. This unique vascularity enables the infection to spread randomly across different spinal regions. These atypical presentations can cause a diagnostic dilemma and may be confused with neoplastic pathologies. MSTB is also associated with a higher incidence of neurological adversities. Case Report: This report describes the experience with three patients (ages 22-45) presenting with progressive neurological deficits and back pain. None of the patients had a prior tuberculosis (TB) history. Magnetic resonance imaging revealed multifocal, non-contiguous spinal lesions involving the cervical, thoracic, and lumbar segments, showing vertebral destruction and cord compression. All patients underwent aggressive surgical intervention, including multilevel decompression, debridement, and long-segment stabilisation. The diagnosis of spinal TB was confirmed by histopathology and cartridge-based nucleic acid amplification test. Following surgery and supervised anti-tubercular therapy, all patients demonstrated neurological recovery. Conclusion: MSTB without pulmonary involvement is rare. This series emphasizes that a combination of early diagnosis, aggressive surgical management, and tailored chemotherapy can lead to favorable outcomes. The cases highlight the importance of recognising atypical spinal TB presentations and adopting a multidisciplinary treatment approach.