Title: Assessment of imaging finding in Spinal tuberculosis
Authors: Dr Dipali Kadam, Dr Saurabh Patil, Dr Avinash Dhok, Dr Meenal Jain
DOI: https://dx.doi.org/10.18535/jmscr/v7i1.93
Abstract
Introduction: Involvement of spine in tuberculosis is most common skeletal manifestation of extra-pulmonary tuberculosis. It is a destructive process involving abscess, collapse of vertebra, end plate irregularities, cord abnormalities and intervertebral disc deformity. X-ray always remains initial imaging modality of choice followed by CT and MRI. Most commonly followed path of assessment includes X-ray and MRI, as bony abnormalities seen best on X-ray and soft tissue abnormalities on MRI. Present study was performed to assess imaging findings in spinal tuberculosis using X-ray and MRI.
Method and Materials: The study was conducted on 50 patients clinically suspected of spinal tuberculosis referred to radiology department for further workup. After taking an informed and written consent, X-ray was taken first, followed by MRI.
Results: Back pain is most common symptom of Spinal TB. Kyphosis, scoliosis, collapse of vertebra, cord edema, involvement of disc, abscess, canal stenosis, reduced bone density and thecal sac indentation were the findings seen in spinal tuberculosis patients. MRI was noted to be a better modality for the evaluation of the canal abnormalities and extent of abscess.
Conclusion: X-ray remains initial imaging modality due to easily available cheap modality and excellent demonstration of bony abnormalities. However, MRI remains best available modality due to its excellent soft tissue demonstration and marrow lesions.
Keywords: Tuberculosis, Pott’s spine, Extra-pulmonary, MRI, Spinal deformity.
References
- World Health Organization. TB Facts 2011 [assessed on 2011 Jun 11].
- Agrawal V, Patgaonkar PR, Nagariya SP. Tuberculosis of spine. J Craniovertebr Junction Spine. 2010;1:74-85.
- Tuli SM. 3rd ed. New Delhi: Jaypee Brothers; 2004. Textbook- Tuberculosis of the skeletal system (Bones, Joints, Spine and Bursal sheaths)
- World Health Organization. 2010/2011 tuberculosis global facts. Facts sheet no 104, 2010 Nov [accessed on 2011 Apr 16].
- Taylor GM, Murphy E, Hopkins R, Rutland P, Chistov Y. First report of Mycobacterium bovis DNA in human remains from the Iron Age. Microbiology 2007;153(4):1243–9 [PubMed]
- Jain AK. Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg Br 2010;92(7):905–13 [PubMed]
- Pawar UM, Kundnani V, Agashe V, Nene A, Nene A. Multidrug-resistant tuberculosis of the spine – is it the beginning of the end? A study of twenty-five culture proven multidrug-resistant tuberculosis spine patients. Spine (Phila Pa 1976) 2009;34(22):E806–10 [PubMed]
- Talbot JC, Bismil Q, Saralaya D, Newton DA, Frizzel RM, Shaw DL. Musculoskeletal tuberculosis in Bradford – a 6-year review. Ann R Coll Surg Engl 2007;89(4):405–9 [PMC free article] [PubMed]
- Omari B, Robertson JM, Nelson RJ, Chiu LC. Pott's disease. A resurgent challenge to the thoracic surgeon. Chest. 1989;95:145–150.
- Shanley DJ. Tuberculosis of the spine: Imaging features. Am J Roentgenol 1995;164:659–64.
- Griffith JF, Kumta SM, Leung PC, Cheng JC, Chow LT, Metreweli C. Imaging of musculoskeletal tuberculosis: a new look at an old disease. Clin Orthop Relat Res 2002;398:32–9.
- Garg RK, Somvanshi DS. Spinal tuberculosis: a review. J Spinal Cord Med. 2011;34(5):440-54.
- McLain RF, Isada C. Spinal tuberculosis deserves a place on the radar screen. Cleve Clin J Med2004;71(7):543–9
- Moon MS. Tuberculosis of the spine. Controversies and a new challenge. Spine (Phila Pa 1976)1997;22(15):1791–7
- Cormican L, Hammal R, Messenger J, Milburn HJ. Current difficulties in the diagnosis and management of spinal tuberculosis. Postgrad Med J2006;82(963):46–51
- Hodgson AR, Wong W, Yau A. X-ray appearance of tuberculosis of the spine. Springfield, IL: Charles C Thomas; 1969
- Ansari S, Amanullah MF, Ahmad K, Rauniyar RK. Pott’s Spine: Diagnostic Imaging Modalities and Technology Advancements. N Am J Med Sci. 2013; 5:404-411.