C6 vertebral fracture secondary to tuberculous spondylodiscitis in a patient with chronic kidney disease

Leema Rebekal Rosy1*, Janet Vasanthi2, Esthar Rani3

1Assistant Nursing Superintendent1, Kauvery Hospital, Tennur, Trichy, Tamil Nadu

2Nursing Incharge, Kauvery Hospital, Tennur, Trichy, Tamil Nadu

3Nursing Superintendent, Kauvery Hospital, Tennur, Trichy, Tamil Nadu

*Correspondence

Abstract

Tuberculous spondylodiscitis is a destructive infection of the spine caused by Mycobacterium Tuberculosis, involving vertebral bodies and intervertebral discs. The disease develops insidiously and may present with chronic neck or back pain, stiffness and constitutional symptoms such as fever, weight loss and night sweats. Progressive vertebral destruction may result in deformity, abscess formation and neurological compromise due to spinal cord compression. This case describes a patient with chronic kidney disease (CKD) on hemodialysis who developed a C6 vertebral fracture secondary to tuberculous spondylodiscitis. The report emphasizes the critical role of nurses in early recognition, multidisciplinary management, postoperative care, and patient education to prevent complications and promote recovery.

Key words: Tuberculous spondylodiscitis; chronic kidney disease (CKD); Spinal tuberculosis

Introduction

Spinal tuberculosis, also known as Pott’s spine, accounts for nearly 50% of skeletal tuberculosis cases. The cervical spine involvement, though less common than thoracolumbar disease, can result in catastrophic neurological deficits due to its proximity to vital neural structures. Early diagnosis and timely multidisciplinary management are vital to prevent permanent disability. Patients with chronic kidney disease are at increased risk of tuberculosis due to immune suppression, poor nutritional status, and repeated hospital exposure. The following report illustrates how tuberculosis-induced cervical spondylodiscitis led to a C6 vertebral fracture in a hemodialysis- dependent patient and highlights the comprehensive nursing care approach essential for optimal outcomes.

Case presentation

A 63-year-old male, a known case of chronic kidney disease on hemodialysis, type 2 diabetes mellitus and systemic hypertension, presented with neck pain radiating to both upper limbs for two weeks. He also reported numbness and weakness of both upper and lower limbs.

There was no history of trauma, fever, or chest pain. The patient was initially treated at another hospital and later referred for further management due to progressive weakness.

On examination

  • Neurological findings: Quadriparesis.
  • Upper limb power: 2/5 (elbow extension), other muscles 4/5.
  • Lower limb power: Flexors/extensors/adductors 3–4/5.
  • Deep tendon reflexes diminished.
  • Sensory deficits present.
  • MRI Brain: Old infarct in left basal ganglia, parietal cortex, age-related cerebral atrophy, small vessel ischemic changes.
  • MRI Cervical Spine: Osteopenia, C6–C7 spondylodiscitis with epidural abscess causing cord compression and diffuse disc bulge at C5–C6 level with anterior thecal sac indentation.

Diagnosis

  • C6–C7 Tuberculous spondylodiscitis with epidural abscess and cord compression.
  • Secondary pathological vertebral fracture.

Medical and surgical intervention

The patient underwent C6–C7 corpectomy and cage stabilization. Postoperatively, the patient showed significant symptomatic improvement with reduction in pain and gradual motor recovery. Histopathological examination confirmed acute inflammatory granulation tissue with reactive fibroblastic proliferation, consistent with tuberculous infection. He was started on antitubercular therapy (ATT), continued hemodialysis and engaged in chest and limb physiotherapy. Once stable, he was discharged with follow-up instructions.

Nursing diagnosis

  • Impaired physical mobility related to spinal cord compression and weakness.
  • Acute pain related to vertebral inflammation and nerve compression.
  • Risk for infection related to surgical wound and immunosuppression.
  • Deficient knowledge related to disease condition and ATT regimen.
  • Risk for impaired skin integrity related to cervical collar use.

Nursing assessment and management

Vital Signs Monitoring

  • Regularly monitored to detect early signs of infection, sepsis or hemodynamic instability.
  • Observed for fever spikes indicating abscess progression or ATT side effects.

Neurological assessment

  • Assessed motor function, Monitor sensory function and reflexes
  • Monitored signs of spinal cord compression such as paresthesia, weakness or bladder/bowel dysfunction.

Pain assessment

  • Evaluated pain intensity and response to analgesics.
  • Ensured adequate pain control to facilitate mobilization and rehabilitation

Spinal stabilization care

  • Ensured proper use of cervical collar or brace to prevent further vertebral injury.
  • Regular skin assessment under the collar to prevent pressure sores.
  • Educated the patient on safe posture and movement techniques.

Monitoring for complications

  • Monitored neurological deterioration, abscess formation or spinal deformity.
  • Monitored for adverse drug reactions to ATT, particularly in CKD patients.
  • Maintained hydration, nutrition and fluid balance during ongoing dialysis therapy.

Medication management

  • Administered ATT and other prescribed drugs on schedule.
  • Ensured timely dialysis and coordinated with the nephrology team.
  • Documented and reported changes in neurological status.

Patient education and support

Educated patient and attendants on:

  • Importance of completing ATT regimen.
  • Proper brace care and posture.
  • Recognizing signs of complications (fever, weakness, pain increase).
  • Infection prevention and hygiene during hemodialysis.

Documentation and communication

  • Maintain detailed records of neurological assessments, medications and vital signs.
  • Promptly communicate deterioration to the physician and multidisciplinary team.

Discussion

Tuberculous spondylodiscitis of the cervical spine carries a high risk of instability and neurological compromise. In patients with chronic kidney disease, immunosuppression and poor healing capacity predispose them to severe infection and delayed recovery. The C6 level is particularly critical due to its role in cervical stability and proximity to spinal cord and vertebral arteries. The management requires a multidisciplinary approach involving neurologists, orthopaedic surgeons, nephrologists, physiotherapists, and nursing professionals. Nursing care focuses on neurological monitoring, infection prevention, medication adherence, spinal stabilization and patient education, which are vital to prevent recurrence and promote rehabilitation.

Conclusion

By providing comprehensive and coordinated nursing care — including vital monitoring, medication administration, infection prevention, fluid balance maintenance, and patient education — nurses play a pivotal role in the recovery of patients with cervical tuberculosis and pathological fractures. This case highlights the importance of early detection, multidisciplinary collaboration, and skilled nursing intervention in managing tuberculous spondylodiscitis with spinal instability in CKD patients.

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