Noncontiguous spinal tuberculosis: incidence and management

Abstract

Tuberculosis (TB) has a worthy reputation as one of the great mimickers in medicine with a multitude of clinical pictures and variations. Noncontiguous spinal TB is described as atypical and case reports are published as rarities in the mainstream academic journals. The aim of the study was to asses the incidence and review of the management of non-contiguous spinal TB. We identified 16 cases of noncontiguous spinal TB from a single surgeon series of 98 patients, who were managed surgically between 2001 and 2006. These were diagnosed on whole spine MRI. This represents the largest series reported in literature to date and is higher than the expected incidence. Case notes and imaging were retrospectively reviewed in an attempt to ascertain if there were any parameters to differentiate this group from the rest of the TB spine population. Our incidence of noncontiguous spinal TB is 16.3%. There was a higher incidence of neurology in the noncontiguous group (75%) compared to the rest of our group (58.5%). Non-contiguous TB was not found to be a manifestation of HIV, MDR TB or of chronicity in our series. Most noncontiguous lesions were evident on plain radiology. Noncontiguous spinal TB is common in areas of high prevalence such as South Africa. Despite being frequently missed initially, noncontiguous involvement is evident on plain radiography and simply requires a higher index of suspicion. When investigating spine TB patients, simple radiology of the entire spine is mandatory. If available, a full spine sagittal MRI is extremely useful in identifying noncontiguous lesions. Treatment of noncontiguous tuberculosis is as for standard spinal TB cases in our unit with similar outcomes, but care needs to be taken in surgical planning as patients may have multiple areas of neurological compromise.

Primary Rifampicin Drug Resistant Disseminated Extrapulmonary Tuberculosis

“…Hence, in all, osteoarticular TB represents 1-2% and TB spondylitis represents 0.5-1% of all TB cases. [12] Contrary to the previously reported drug resistance, presentation was different in our case. Here the patient neither had history of tuberculosis in the past or any contact history indicating primary resistance.…”

Imaging findings of Pott’s disease

“…Musculoskeletal involvement of TB is estimated in 1-13 % of patients and spine is affected in more than 50 % of cases [2][3][4][5][6][7][8][9]. It is most prevalent in adults with no sex predominance [10][11][12].…”

Isolated atypical spinal tuberculosis mistaken for neoplasia: case report and literature review

“…The inflammatory markers of these patients may be within the normal range and without any bony destruction. Granulomas could be found in the canal and sometimes accompanying dorsal soft tissue abscess in operation [9]. However, our patient was a healthy 45-yearold female.…”

“…But MRI is more sensitive in diagnosing tuberculous spondylitis. It can detect abnormal bone marrow with a low signal on T1-weighted images as well as a high signal on T2-weighted images which can not be detected by radiographs and CT scans [4,5]. In addition, special MRI sequences such as T1?…”