Spinal tuberculosis, the most common form of skeletal involvement in tuberculosis, is usually the result of hematogenous seeding of the vertebral body, and the diagnosis often remains elusive because of the indolent nature of the infection. Initial vertebral body involvement may be indistinguishable from early pyogenic spondylitis; however, the disc space is uniquely spared in the early and intermediate phases of tuberculous spondylitis, in contrast to pyogenic bacterial infections. Tuberculous spondylitis is one of the more common infections of spine in countries where TB is prevalent. Vertebral body collapse is much more common with TB than with pyogenic infections, creating the classic “gibbus deformity” of short segment kyphosis ( Fig. Tuberculosis of spine 1. (A and B) Axial CT scan shows destruction of laminae and spinous process. TB can also affect the meninges of the spine, causing an intense pachymeningitis that enhances dramatically. Spinal tuberculosis is rare in the UK but in developing countries it represents about 50% of musculoskeletal tuberculosis . ... 3 Department of Radiology, Ealing Hospital, London North West University Healthcare NHS Trust, Southall, Middlesex, UK. A reduction in vertebral height is often seen with the irregularity of the anterosuperior end plate being relatively early and subtle sign. Lippincott Williams & Wilkins. This results in an acute kyphotic or "gibbus" deformity. (2007) ISBN:0781738954. Classically, spinal tuberculosis is thought to begin in the anteriorjinferior portion of the vertebral body [6, 7]. Constitutional symptoms (fever and weight loss) are also common but not as pronounced as with bacterial diskitis/osteomyelitis. Spinal infection-tuberculosis. Unlike pyogenic infections, the discs can be preserved and it more commonly involves the thoracic spine. The goal of early diagnosis is avoiding significant morbidity associated with spinal instability, which may occur with delayed treatment. Patients usually present with back pain, lower limb weakness/paraplegia, and kyphotic deformity. AJR Am J Roentgenol. After suspicious imaging abnormalities are identified in the spine, percutaneous image-guided bone or soft tissue biopsies can be performed. Brant WE, Helms CA. Neurologic complaints are much more common at this stage of the disease because the kyphosis can result in compression of the anterior spinal cord. Spinal tuberculosis or Pott's disease is an infection of the vertebral column caused by Mycobacterium tuberculosis. The prevalence of tuberculosis (TB) has increased in developing and developed countries as a consequence of the AIDS epidemic, immigration, social deprivation, and inadequate TB control and screening programs. Tuberculosis of the spine: imaging features. Classic findings of … 13. 5. Imaging revealed ost… Shanley DJ(1). ADVERTISEMENT: Supporters see fewer/no ads. Spinal infection-tuberculosis. ADVERTISEMENT: Supporters see fewers/no ads. Spinal tuberculosis (TB) is the most common extrapulmonary manifestation of TB disease. Vertebral osteomyelitis: assessment using MR. Radiology 1985;157(1):157–166. Histopathology of the bone biopsy may show nonspecific granulomatous changes suggesting TB. By Dr Shahid LatheefDepartment of OrthopaedicsYenepoya Medical CollegeMangalore 2. Furthermore, the classic constitutional symptoms of TB (e.g., fever, night sweats, weight loss) are present in less than 40% of spinal cases and may not become clinically apparent for months after initial spinal involvement. Tuberculosis (TB) of the central nervous system (CNS) is a granulomatous infection caused by Mycobacterium tuberculosis.The disease predominantly involves the brain and meninges, but occasionally, it affects the spinal cord. Within endemic countries, tuberculous spondylitis typically affects children and young adults during primary lung infection; however, in Western countries adults are more commonly affected after reactivation of latent disease. Tuberculous spondylitis, also known as Pott disease, refers to vertebral body osteomyelitis and intervertebral diskitis from tuberculosis (TB). Among these, tuberculous infection of the spine is the most common. Of all the victims, children amount to about 10–33% , , , . 1 As a result, the radiographic findings and the signs and symptoms are typically far advanced when the diagnosis is finally established. 1. It causes a kind of tuberculous arthritis of the intervertebral joints. Rajendra Kumar4, Sowmya Jagadish5, Pradeep Hagalahalli Nagarajegowda6, Ashwin Raghavendra7 1 Resident, 2Assistant Professor, 3Professor, … The prevalence of tuberculosis has continued to decline in the United States over the past few years. Spinal tuberculosis: atypical observations at MR imaging. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Ragland RL, Abdelwahab IF, Braffman B, Moss DS. 27.1 ). Diskitis and/or osteomyelitis comprise approximately 50% of all musculoskeletal tuberculosis, and usually affects the lower thoracic and upper lumbar levels of the spine 2. DR HARDIK PAWARTUBERCULOSIS OFSPINE“Yakshma” 2. common in INDIA 1-3% -osseous involvement >50% affects spinal column - commonest form of skeletal TB. Objectives: A review of literature on the epidemiology, diagnosis, and management of spinal tuberculosis (TB). TB infection is spread hematogenously either arterially or by Batson venous plexus, with the primary exposure site occurring in the lungs or genitourinary system. Involvement of the posterior elements is rare ( Fig. Less than half of these patients will have simultaneous pulmonary infection. Tuberculosis (TB) is classically considered an infectious disease of developing countries; however, it has made a resurgence in other areas of the world with the increased use of immunosuppressive drugs, increased immigration, and the relatively recent appearance of HIV. Harisinghani MG, Mcloud TC, Shepard JA et-al. Dähnert W. Radiology review manual. Check for errors and try again. Author information: (1)Department of Radiology, University of Southern California School of Medicine, LAC-USC Medical Center 90033. Pott disease is tuberculosis of the spine, usually due to haematogenous spread from other sites, often the lungs. Bone destruction with peripherally enhancing intraosseous abscesses and thin-walled subligamentous paraspinal abscesses demonstrating limited surrounding inflammatory phlegmonous changes is commonly encountered prior to involvement of the disc space. 3. J Bone Joint Surg Br 1993; 75(2):233–239. Spinal TB may be osseous or nonosseous. Spinal tuberculosis and tuberculous psoas abscess. Cross-sectional imaging is required to assess better the extent of involvement and particularly for the presence of an epidural component and cord compression. When compared with pyogenic infections of the spine, tuberculous spondylitis has a distinct pattern of spinal involvement on imaging, as well as a unique pattern of progression that warrants its own description. Tuberculous spinal infections are most often encountered in the lower thoracic or upper lumbar spine, although any spinal segment may be involved. C44 International ournal o Conteorar Medicine Surger and Radiology Volume 3 Issue 3 July-September 2018 MRI Evaluation of Tuberculosis of Spine Rashmi U. Turamari1, Pradeep Kumar Chandandur Nagarajaiah2, Chakenalli Puttaraju Nanjaraj3, N.L. However, the smallest annual decrease in the past 10 years occurred in 2003, with the reported prevalence of tuberculosis actually rising in some states and in certain populations (,1). Unfortunately, the incidence of tuberculous spondylitis, as with other forms of TB, is on the rise, due to new multiple drug resistant strains. Tuberculous spondylitis is one of the more common infections of spine in countries where TB is prevalent. [] Clinical diagnosis can be difficult; therefore, imaging has an important role in establishing the diagnosis (see the images below). 1. The lower thoracic and upper lumbar vertebrae areas of the spine are most often affected.. Author information: (1)Department of Radiology, Tripler Army Medical Center, Honolulu, HI 96859. 6. The most vulnerable infection site for pediatric tuberculosis is the respiratory system, which accounts for about 47%. Fundamentals of diagnostic radiology. Ahmadi J(1), Bajaj A, Destian S, Segall HD, Zee CS. TB infection is spread hematogenously either arterially or by Batson venous plexus, with the primary exposure site occurring in the lungs or genitourinary system. Radiology (X-rays) is used in the diagnosis of tuberculosis.Abnormalities on chest radiographs may be suggestive of, but are never diagnostic of TB, but can be used to rule out pulmonary TB. Tuberculosis from head to toe. Anatomically, the thoracic spine is the most commonly affected site followed by the lumbar and cervical vertebrae in turn. spinal cord injury can be caused by abscess/bony sequestra or meningomyelitis; abscess/bony sequestra has a better prognosis than meningomyelitis as the cause of spinal cord injury; Atypical Spinal Tuberculosis: definition compressive myelopathy without visible spinal deformity, without typical radiological appearance Between 1990 and 1993, five of 11 consecutive patients with spinal tuberculosis (two men and three women, aged 30-57 years) had MR findings more suggestive of neoplasm than infection. 27.2 ). Radiologic examinations are one of the first and most important steps in establishing the diagnosis of tuberculous spondylitis. Spread of infection can occur beneath the longitudinal ligaments involving the adjacent vertebral bodies. {"url":"/signup-modal-props.json?lang=us\u0026email="}, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":8759,"mcqUrl":"https://radiopaedia.org/articles/tuberculous-spondylitis-2/questions/1655?lang=us"}, tuberculous spondylitis versus pyogenic spondylitis, compared to pyogenic infection tuberculous spondylitis has relatively preserved disk-space height, forms large paraspinal abscesses with a smooth enhancing wall and there is usually systemic involvement of multiple organs. Spinal tuberculosis (Pott disease) is not an uncommon manifestation. This condition is of great diagnostic importance due to its link to neurologic deficits and painful spinal deformities.… Spinal Tuberculosis (Disease Pott): Read more about Symptoms, Diagnosis, Treatment, Complications, Causes and Prognosis. In spinal tuberculosis, the superior contrast resolution of MR imaging is useful for showing contiguous vertebral involvement, skip lesions, and paraspinal collections. Radiology. Tuberculous spondylitis can be difficult to detect in early stages because of relative preservation of the disc space. respond well to simple decompres- tension. 2. This increase has been seen not only in Africa and Asia, bu… Spinal TB may be osseous or nonosseous. It manifests secondary to extension through hematogenous route. PURPOSE: To evaluate atypical magnetic resonance (MR) imaging features of spinal tuberculosis. Link, Google Scholar Discrimination of tuberculous spondylitis from pyogenic spondylitis on MRI. Later, paraspinal collections can develop which can be remarkably large. DIFFERENCES OF MRI FEATURES BETWEEN TUBERCULOUS AND BACTERIAL SPONDYLITIS IN A TB-ENDEMIC AREA. Spinal TB patients typically present with back pain but other constitutional or pulmonary symptoms may be absent, rendering the diagnosis difficult. This classical late stage appearance of severe focal kyphosis was first described by English surgeon Sir Percivall Pott in 1779 (hence the use of the term Pott disease). 1993;189: 489 ... role of posterior instrumentation and fusion after anterior radical debridement and fusion in the surgical treatment of spinal tuberculosis: experience of 127 cases. Diskitis and/or osteomyelitis comprise approximately 50% of all musculoskeletal tuberculosis, and usually affects the lower thoracic and upper lumbar levels of the spine 2. The usual duration of illness ranges from 4 to 11 months. This is a classical appearance with TB spondylitis. (2019) Radiographics : a review publication of the Radiological Society of North America, Inc. 39 (1): 287-288. 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