Spinal tuberculosis with concomitant spondylolisthesis: coexisting entities or 'cause and effect'?

Study design: Report of three unusual cases of coexisting spondylolisthesis and tuberculosis in the same patient. Objectives: To document the rare occurrence and attempt to postulate the probable reasons for such an association. Setting: Tertiary care teaching hospital in a developing country. Methods: This communication reports the outcome of three cases where there was spondylolisthesis and spinal tuberculosis in the same patient. The probable reason for such an occurrence is discussed along with a literature review relevant to this topic. Results: The cases responded favorably to conservative treatment with multidrug antitubercular chemotherapy and spinal braces. Conclusions: Association of spondylolisthesis and spinal tuberculosis is extremely rare. If the tubercular process is fulminant, spondylolisthesis secondary to destruction of posterior elements by the infective process can occur. Gross destruction of anterior elements secondary to tuberculosis in some patients may place excessive stresses on the posterior elements and may precipitate a spondylolisthesis even if there was no active infection in the posterior elements. However, there remains a distinct possibility that pars defect may have existed prior to infective pathology.