Novel magnetic resonance imaging scoring system for diagnosis of spinal tuberculosis: A preliminary report

Abstract

Background:There exists a lot of ambiguity in the preoperative diagnosis of the various vertebral lesions. Mostly in these patients tuberculosis of spine (TB) is suspected due to endemicity of the disease in the Indian subcontinent. However, no definite guidelines are available to diagnose tuberculous (TB) vertebral lesions in the current literature.Study Design:This prospective study was conducted in the Department of Neurosurgery, Nizam's Institute of Medical Sciences, from August 2009 to March 2012.Aim of the Study:To formulate non invasive methods to diagnose tuberculous vertebral lesions confidently so that the dependency on histopathologic diagnosis can be reduced.Material and Methods:Spinal MRI images of 45 patients suspected of having tuberculosis aetiology were included in the study prospectively.Results:A total of 64 patients were analysed and 19 patients were excluded due to lack of regular follow up or histological proof. The patients were divided into two groups; those with TB of the spine and those with some other condition affecting the spine (non TB spine) based on the final diagnosis. Of the 45 patients males were 30 (66.6%) and females were 15 (33.3%). There was no significant difference in the mean age of presentation. For TB patients this was 41 ± 15.56 years and in Non TB was 43 ± 18.27 years. All patients presented with backache in either group. There was epiphyseal involvement (100%), disc height reduction (71.42%) and pedicle destruction (42.82%) in plain X-rays in the TB group. Lumbar spine was the most common affected region in our study (26.31% in non TB and 34.6% in TB group of patients). Significant P value and the Odds Ratio was found for T1 hypo intensity, T2 hyper intensity, epiphyseal involvement, disc involvement, pedicle involvement, anterior subligamentous extension, paraspinal extension and no spinous process involvement (eight parameters). The eight parameters were tested among both the groups and it was noted that scores ≥ 6 favored a tuberculous pathology whereas ≤4 were suggestive of non tuberculous etiology.Conclusions:The eight point MRI criteria of the vertebral lesions are likely to enhance the diagnostic ability of tuberculous and non tuberculous pathologies thereby reducing the dependency on histopathologic diagnosis or invasive method for early initiation of therapy.

An Unusual Case of CV Junction Tuberculosis Revealed as Post-Traumatic Cervical Pain

“…Delays in diagnosis are due basically to the insidious onset, absence of constitutional signs, delayed reporting or attending to a physician all that coupled with lack of single diagnostic test for diagnosing TB. When dealing with spinal diseases, the clinician is faced to the problem of diagnosis despite advanced imagenological studies, subjecting patients to invasive procedures for final diagnosis 6 . Spinal TB is a secondary localization of pulmonary tuberculosis and should be considered as a metastasis.…”

The importance of early diagnosis with magnetic resonance imaging in spinal tuberculosis

“…[5] In addition, the repeat MRI at close distances allows to identify the different stages of the disease: Paravertebral abscesses characteristic or progressive discal and vertebral involvement. [6] Spinal tuberculosis is a secondary localization of pulmonary tuberculosis and should be considered as a metastasis. So the patients being diagnosed pulmonarytuberculosis or persons with multiple exposures to mycobacteria whose have a strong suspicion that they may have contracted the disease, must be analyzed for any second vertebral locations before they submit the symptoms.…”

“…So the patients being diagnosed pulmonarytuberculosis or persons with multiple exposures to mycobacteria whose have a strong suspicion that they may have contracted the disease, must be analyzed for any second vertebral locations before they submit the symptoms. The alterations that can be identified by MRI (T1 hypo intense, T2 hyper intense, Disc involvement, Epiphyseal involvement, pedicle involvement, Anterior subligamentous extension, Paraspinal extension, No involvement of spinous process) can give a correct orientation to begin early treatment, [6] like minimally invasive surgerywith the least morbidityand better out-come. [1,3,4]…”

Commentary

“…Several original works from India are now available in the literature about classification of Pott's spine. [9][10][11] Bhojraj and Mehta proposed a classification system, using information provided by MRI, to help to plan the appropriate surgical treatment for patients with thoracic spinal TB. [9] They describe a series of 47 patients, divided into four groups, based on the surgical protocol used in the management.…”

“…The risk factors for severe increase of deformity are: (i) patients less than 10 years of age at the onset of the disease, (ii) an initial kyphosis angle of more than 30°, (iii) vertebral body loss of greater than 1.5, (iv) involvement of more than three vertebral bodies, (v) presence of "spine at risk" signs in radiographs, global involvement of the vertebrae, and (vi) children who have partial or no fusion during adolescent growth spurt. Chandrasekhar et al, [11] have very recently proposed a novel classification on pragmatic MRI-based criteria [11] Their eight point MRI criteria of the vertebral lesions are likely to enhance the diagnostic ability of tuberculous (and also differentiation from nontuberculous pathologies), thereby reducing the dependency on histopathologic diagnosis or invasive method for early initiation of therapy.…”