Fig. 2.

Male patient, 35 years old. The patient presented with a persistent backache for 1 year and was admitted to our clinic in 2007. a, b Preoperative radiograph and CT showed destruction of T8-11 vertebrae. c MRI additionally showed paravertebral abscess formation and compression of the spinal cord. The patient underwent one-stage anterior debridement, autograft fusion and instrumentation after admission. However, the patient refused to undergo DST for economic reasons. He received a combination of rifampicin and isoniazid, provided by the local Centre for Disease Control for free, after discharge from the hospital. d, e At a four-month follow-up, radiography and CT revealed the failure of the fusion and instrumentation. f Severe incision dehiscence was also observed. The patient received a repeated, single-stage anterior radical debridement, posterior autograft fusion and instrumentation. Forty-three days postoperatively, the result of DST demonstrated that the M. tuberculosis strain was resistant to isoniazid. Then the patient received a modified regimen, including pyrazinamide, ethambutol, rifapentine, levofloxacin and streptomycin, for 24 months. Streptomycin was discontinued after six months of treatment. g, h, i Three-year follow-up radiographs and CT showed the infected site had healed, and satisfactory bony fusion was achieved. j The sinus tract achieved complete cure, and the ESR was decreased to 2 mm/h