Diagnosis and Treatment of Skipped Multifocal Spinal Tuberculosis Lesions

Abstract

Spinal tuberculosis, also known as Pott's disease or tuberculous spondylitis, is usually secondary to primary infection in the lungs or other systems, and in most instances, is thought to be transmitted via blood. Typical manifestations of infection include narrowing of the intervertebral disc by erosion and bone destruction of adjacent vertebrae. Atypical spinal tuberculosis is a specific type of spinal tuberculosis. It mainly consists of single vertebral lesions, single posterior structure lesions, multiple vertebral lesions, and intra-spinal lesions. Skipped multifocal spinal tuberculosis is one of these types and is characterized by two or more vertebral lesions without the involvement of the adjoining intervertebral discs, regardless of their location. To date, only a few cases have been reported. Upon clinical admission, it can be treated conservatively or surgically, depending on the patient's symptoms. In addition, gene or biological therapies are being investigated. However, because of the exceptional imaging findings and insidious symptoms, it is often misdiagnosed as a neoplastic lesion, osteoporotic fracture, or other infectious spondylitis, increasing the risk of neurological deficit and kyphotic deformity, and delaying the optimal treatment window. In this study, we review the diagnosis and treatment strategies for skipped multifocal spinal tuberculosis lesions and enumerate the common differential diagnoses, to provide reference and guidance for clinical treatment and diagnosis direction.

Magnetic Resonance Imaging (MRI) Images in Tuberculosis Spondylitis Patients at the Central General Hospital Prof. Dr. I.G.N.G. Ngoerah Year 2021-2023

“…In the osteolytic phase, M. tuberculosis will cause very low vertebral regeneration. This results in extensive spinal damage or severe gibbus deformity (11). In this study, spinal cord compression results were obtained in the form of (96%) patients experiencing spinal cord compression.…”

Rehabilitation management of patients with spinal tuberculosis (Review)

“…Pain is the main complaint of patients with ST. Of note, 90 to 100% of patients complain of back pain ( 11 ). The immobilization of the affected spinal segment with adequate equipment (a corset in the case of lumbar or dorsal involvement and a cervical collar in the case of cervical spine involvement) and in some cases, strict bed rest, are primordial measures used to decrease the intensity of pain ( 12 ).…”

Differentiation of Native Vertebral Osteomyelitis: A Comprehensive Review of Imaging Techniques and Future Applications

“…Differential diagnosis of TS is important for clinical management, especially in those with spinal bone destruction. Atypical spinal tuberculosis, including skip multifocal spinal tuberculosis, can be misdiagnosed as a neoplastic lesion or other infectious spondylitis, leading to delayed treatment [ 31 , 34 ]. Spinal tumors tend to involve vertebral bodies and posterior elements, which cannot be strongly differentiated from the variable imaging features of TS.…”