Role of Magnetic Resonance Imaging in Evaluation of Tubercular Spondylitis: Pattern of Disease in 100 Patients with Review of Literature

Abstract

Introduction: The purpose of this study is to evaluate the role of magnetic resonance imaging (MRI) in evaluation of tubercular spondylitis and to correlate imaging findings with clinical severity of the disease.
 Methods: One hundred consecutive patients, who presented with features suggestive of spinal infections, were subjected to MRI examination. T1W and STIR images were obtained followed by T2W and post-contrast T1W images. Various imaging characteristics of spinal infections were noted and correlated with the clinical severity of the disease.
 Results: Backache was the most common presenting symptom present in 86 %, while paraparesis was the most common sign seen in 62 %. The neurological status of the patients correlated well with MRI findings in the majority of the cases with an overall good correlation obtained in 96 % of cases. The majority of the vertebrae and intervertebral discs affected showed hypointensity or isointensity on T1W images and hyperintensity on T2W images. Epidural/dural disease was present in 74 % while 68 % of patients demonstrated decreased intervertebral disc height. Epidural extension and subligamentous spread was in 74 % and 90 % of patients respectively.
 Conclusions: MRI plays a vital role in early and accurate diagnosis of spinal infections. It is non-invasive and clearly demonstrates soft tissue anatomy and pathology which makes it superior to X-rays and Computed Tomography (CT). Imaging findings of tubercular spondylitis were also found to have a good correlation with the clinical status of the patients. Hence, it is of much help in the evaluation and assessment of patients presenting with features of spinal infections. 
 Keywords: Magnetic resonance imaging, spinal tuberculosis, tubercular spondylitis

Correlation between neurological recovery and magnetic resonance imaging in Pott’s paraplegia

“…They were classified into ASIA impairment scale A-D. 20% of the patients (12/60) had normal neurological status at presentation hence classified into ASIA E. Thus, most of our patients (60%) had mild neurological deficit (ASIA D) with lower limb power >3/5 and normal anal tone. In a similar study, Khalid et al 18. showed mild neurological deficit in 75% of their patients.…”

Spondylodiscitis: experience of surgical management of complicated cases after failed antibiotic treatment

“…It is also valuable in distinguishing between pyogenic and granulomatous SD and also in differential diagnosis between SD and other causes of vertebral destruction; mainly malignancy [1]. The fact that 7 (17.5%) patients had a final histopathological examination results of caseating granuloma (classically from TB infection) supports the suggestion that despite its global regression over the past few decades, TB is still a main cause of bone and joint infection in developing countries [31,32].…”

The challenges in differentiating tuberculous from pyogenic spondylitis using magnetic resonance imaging

“…Thus, pyogenic spondylitis is often detected earlier, with a fewer number of involved corpus vertebrae than tuberculous spondylitis. [6][7][8]14 Overall patients with pyogenic spondylitis showed a contrast enhancement in intervertebral discs, in eight patients (100%). In contrast, 75% of patients with tuberculous spondylitis did not show enhancement of the intervertebral discs.…”

“…It is noted that tuberculous spondylitis occurs in 1% of all tuberculous infection patients, and 25%-60% of bone and joint infections are caused by tuberculosis. [6][7][8][9] Research conducted by Lee stated that pyogenic spondylitis is a rare disease with a prevalence of ~0.15%-3% in osteomyelitis cases. 9 Tuberculous spondylitis requires completely different therapy from with non-tuberculous spondylitis, so it is important to distinguish between the two types of spondylitis.…”