Unexpected cervical tuberculosis presenting as a compression fracture: early expandable cage failure requiring revision and a systematic review

Background Cervical spinal tuberculosis is a rare manifestation of extrapulmonary tuberculosis and may mimic traumatic vertebral fractures or metastatic malignancy because of its nonspecific clinical and radiological features. Instrumentation-related complications in the setting of active spinal infection are uncommon but may significantly affect surgical outcomes. Case Description A 77-year-old female presented with progressive neck pain and right upper-extremity radiculopathy following minor trauma. Imaging demonstrated destructive involvement of the C6–C7 vertebrae with kyphotic deformity, while positron emission tomography-computed tomography revealed hypermetabolic vertebral lesions, pulmonary nodules, and mediastinal lymphadenopathy, raising suspicion for metastatic disease. The patient underwent anterior cervical corpectomy, expandable cage reconstruction, and anterior plate fixation. Early postoperative implant failure occurred with cage migration and screw dislocation, necessitating urgent revision surgery. Histopathological examination revealed caseating granulomatous inflammation, and the diagnosis of cervical spinal tuberculosis was supported by positive QuantiFERON-TB testing and clinicoradiological findings. A systematic review of the literature identified 11 comparable cases from 8 studies. Mechanical failure of spinal instrumentation was rarely reported, highlighting the unusual nature of the present case. Conclusion Cervical spinal tuberculosis should be considered in the differential diagnosis of destructive cervical spine lesions, particularly when radiological findings mimic malignancy. Active infection, poor bone quality, and extensive vertebral destruction may contribute to early implant failure. Careful surgical planning and close postoperative surveillance are essential to optimize outcomes in these challenging cases.