However, newer multidrug resistant TB strains have been discovered, necessitating prolonged and aggressive treatment regimens. Tuberculosis: a radiologic review. ADVERTISEMENT: Supporters see fewer/no ads. Dorsal spine - most commonly involved Most Common – first 3 decades. The usual duration of illness ranges from 4 to 11 months. ABSTRACT : Spinal tuberculosis, the most common form of skeletal involvement, is increasing in prevalence because of the resurgence of tuberculosis during the past decade in patients with AIDS, the spread of tuberculosis among the homeless, and the expanding immigrant population. Unlike pyogenic infections, the discs can be preserved and it more commonly involves the thoracic spine. (2007) ISBN:0781738954. Spinal tuberculosis is relatively rare, making up only 5% . The lower thoracic and upper lumbar vertebrae areas of the spine are most often affected.. In spinal tuberculosis, the superior contrast resolution of MR imaging is useful for showing contiguous vertebral involvement, skip lesions, and paraspinal collections. 6. TB infection is spread hematogenously either arterially or by Batson venous plexus, with the primary exposure site occurring in the lungs or genitourinary system. Spinal TB may be osseous or nonosseous. Lastly, spinal TB is far from a new disease. Neurologic complaints are much more common at this stage of the disease because the kyphosis can result in compression of the anterior spinal cord. 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. 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. 10.1055/b-0038-162845 8 Spinal Tuberculosis: Pathogenesis, Clinical Features, and InvestigationsRishi M. Kanna, Ajoy Prasad Shetty, and S. Rajasekaran Introduction Chronic infections of the vertebral column are usually granulomatous and are caused by mycobacteria, fungi, and Brucella species. 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. The musculoskeletal system is the most common extrapulmonary site of TB infection, with spinal involvement seen in 50% of skeletal cases. Tuberculous spondylitis can be difficult to detect in early stages because of relative preservation of the disc space. AJR Am J Roentgenol. Tuberculous spondylitis is one of the more common infections of spine in countries where TB is prevalent. Notably, TB is notoriously difficult to isolate on cultures, averaging 4 to 6 weeks to obtain results, with a sensitivity of 80%. Cross-sectional imaging is required to assess better the extent of involvement and particularly for the presence of an epidural component and cord compression. The infection can spread from two adjacent vertebrae into the adjoining intervertebral disc space. 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). 20 (2): 449-70. Spinal tuberculosis is rare in the UK but in developing countries it represents about 50% of musculoskeletal tuberculosis . Anatomically, the thoracic spine is the most commonly affected site followed by the lumbar and cervical vertebrae in turn. Pott disease, also known as tuberculous spondylitis, is one of the oldest demonstrated diseases of humankind, having been documented in spinal remains from the Iron Age in Europe and in ancient mummies from Egypt and the Pacific coast of South America. 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. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Disc destruction is typically not present in tuberculous spondylitis, which is thought to be due TB’s lack of proteolytic enzymes, which are present in most pyogenic bacterial infections. DR HARDIK PAWARTUBERCULOSIS OFSPINE“Yakshma” 2. common in INDIA 1-3% -osseous involvement >50% affects spinal column - commonest form of skeletal TB. Histopathology of the bone biopsy may show nonspecific granulomatous changes suggesting TB. Tuberculous spondylitis refers to vertebral body involvement with TB. The spread of infection is typically described as 'sub-ligamentous': beneath the anterior longitudinal ligament, usually sparing the posterior elements and often involving multiple levels. MRI is the modality of choice for this, with CT with contrast being a distant second. [] Clinical diagnosis can be difficult; therefore, imaging has an important role in establishing the diagnosis (see the images below). Spinal infection-tuberculosis. Radiographics. This angulation, coupled with epidural granulation tissue and bony fragments, can lead to cord compression. Due to the subligamentous extension, there may be some irregularity of the anterior vertebral margin. In late-stage spinal TB, large paraspinal abscesses without severe pain or frank pus are common, leading to the expression "cold abscess". Acid-fast staining or polymerase chain reaction can be used to quickly identify the organism when specifically suspected. Involvement of the posterior elements is rare ( Fig. 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 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. J Spinal Disord Tech. MR imaging provides critical information about the spinal cord and the extent of the epidural pus in patients presenting with neurologic deficits. Check for errors and try again. {"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. TB infection is spread hematogenously either arterially or by Batson venous plexus, with the primary exposure site occurring in the lungs or genitourinary system. The cryptic clinical and microbiology features of this disease accentuate the need for an accurate imaging diagnosis. 5. This increase has been seen not only in Africa and Asia, bu… Less than half of these patients will have simultaneous pulmonary infection. Lippincott Williams & Wilkins. Author information: (1)Department of Radiology, Tripler Army Medical Center, Honolulu, HI 96859. The radiologic infections of the spine and their diagnostic value. Bone and joint involvement constitute about 10% of extrapulmonary TB cases, with the spine being the most frequently affected site. Spinal tuberculosis or Pott's disease is an infection of the vertebral column caused by Mycobacterium tuberculosis. 27.2 ). Spinal tuberculosis (Pott disease) is not an uncommon manifestation. Burrill J, Williams CJ, Bain G et-al. Radiologic examinations are one of the first and most important steps in establishing the diagnosis of tuberculous spondylitis. Spinal Tuberculosis: Current Concepts S. Rajasekaran, PhD, FRCS, MCh1, Dilip Chand Raja Soundararajan, MS1, Ajoy Prasad Shetty, MS1, and Rishi Mugesh Kanna, MS1 Abstract Study Design: Review article. (2007) ISBN:0781765188. Spinal tuberculosis and tuberculous psoas abscess. Classic findings of … Link, Google Scholar Tuberculous spondylitis, also known as Pott disease, refers to vertebral body osteomyelitis and intervertebral diskitis from tuberculosis (TB). There has also been an increase in global prevalence, particularly in immunocompromised patients, with a rate of increase of approximately 1.1% per year (,2). PURPOSE: To evaluate atypical magnetic resonance (MR) imaging features of spinal tuberculosis. Spinal tuberculosis (TB) is the most common extrapulmonary manifestation of TB disease. After suspicious imaging abnormalities are identified in the spine, percutaneous image-guided bone or soft tissue biopsies can be performed. Radiology 1973; Cases of arch tuberculosis usually spinal and paraspinal soft tissue ex- 109:291–296. 16. Harisinghani MG, Mcloud TC, Shepard JA et-al. Download : Download full-size image; Fig. 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. After the vertebral body is involved, the infection will spread along the undersurface of the longitudinal ligaments to involve multiple adjacent vertebrae and into the epidural/paraspinal soft tissues to form abscesses. Vertebral osteomyelitis: assessment using MR. Radiology 1985;157(1):157–166. J Bone Joint Surg Br 1993; 75(2):233–239. TB can also affect the meninges of the spine, causing an intense pachymeningitis that enhances dramatically. As a result, microbiology data are often negative. Unable to process the form. ... 3 Department of Radiology, Ealing Hospital, London North West University Healthcare NHS Trust, Southall, Middlesex, UK. 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. 1 As a result, the radiographic findings and the signs and symptoms are typically far advanced when the diagnosis is finally established. Among these, tuberculous infection of the spine is the most common. Vertebral body collapse is much more common with TB than with pyogenic infections, creating the classic “gibbus deformity” of short segment kyphosis ( Fig. Radiology. 1. Of all the victims, children amount to about 10–33% , , , . Tuberculosis, as an infectious disease raging around the world, poses potential threats. Patients usually present with back pain, lower limb weakness/paraplegia, and kyphotic deformity. In some instances the diagnosis may be delayed by more than a year. Lateral radiogram reveals severe colapse of T7 with kyphotic deformity. Spinal tuberculosis is a destructive form of tuberculosis. Later, paraspinal collections can develop which can be remarkably large. We report a case of a 39-year-old woman presenting with vague back swelling for many years. Ahmadi J(1), Bajaj A, Destian S, Segall HD, Zee CS. Constitutional symptoms (fever and weight loss) are also common but not as pronounced as with bacterial diskitis/osteomyelitis. Pott disease is tuberculosis of the spine, usually due to haematogenous spread from other sites, often the lungs. Spinal tuberculosis and tuberculous psoas abscess. The goal of early diagnosis is avoiding significant morbidity associated with spinal instability, which may occur with delayed treatment. Disk-space narrowing occurs secondarily and therefore usually is limited relative to … Unfortunately, the incidence of tuberculous spondylitis, as with other forms of TB, is on the rise, due to new multiple drug resistant strains. Jung NY, Jee WH, Ha KY et-al. A reduction in vertebral height is often seen with the irregularity of the anterosuperior end plate being relatively early and subtle sign. Spinal infection-tuberculosis. Tuberculous spinal infections are most often encountered in the lower thoracic or upper lumbar spine, although any spinal segment may be involved. Brant WE, Helms CA. Low density changes consistent with an abscess in the posterior muscles group. Ivory vertebrae can result with re-ossification. 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. Similar to pyogenic infections, the anterior vertebral end plate is typically the first site of involvement in the spine, followed by involvement of the central vertebral body. Acute Nontraumatic Back Pain: Infections and Mimics. Unfortunately, the incidence of tuberculous spondylitis, as with other forms of TB, is on the rise, due to new multiple drug resistant strains. Classic findings of multiple contiguous vertebral body involvement, gibbus formation, and subligamentous spread with paravertebral … Features include irregularity of both the endplate and anterior aspect of the vertebral bodies, with bone marrow edema and enhancement seen on MRI: The paraspinal collections are typically well circumscribed, with fluid centers and well-defined enhancing margins 7. Author information: (1)Department of Radiology, University of Southern California School of Medicine, LAC-USC Medical Center 90033. 4. Spread of infection can occur beneath the longitudinal ligaments involving the adjacent vertebral bodies. 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. 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). Spinal tuberculosis: atypical observation at MR imaging. This results in an acute kyphotic or "gibbus" deformity. 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. Radiographics. • The primary problems today are : The delay in diagnosis (average 3months) The long recovery period (average 12months) The great cost of treating such infections. 7. 1995 Mar;164(3):659-64. AJR Am J Roentgenol. 13. 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. Shanley DJ(1). Most patients will seek medical care only after developing severe pain or neurologic complications. Abstract A retrospective study was performed in order to document the sequence and time scale of radiological changes occurring during the healing of spinal tuberculosis. As a result, the clinical diagnosis of early spinal TB can be difficult in patients without a known history of pulmonary TB. By Dr Shahid LatheefDepartment of OrthopaedicsYenepoya Medical CollegeMangalore 2. 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. 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. Discrimination of tuberculous spondylitis from pyogenic spondylitis on MRI. Presentation and imaging can be specific, and the imaging differential diagnosis for this case includes other lytic bone lesions such as metastases and lymphoma. Ragland RL, Abdelwahab IF, Braffman B, Moss DS. ADVERTISEMENT: Supporters see fewers/no ads. In many parts of the developing world, TB is the most common cause of vertebral body infection, with the majority of cases seen in patients under the age of 20. The prevalence of tuberculosis has continued to decline in the United States over the past few years. 2004;182 (6): 1405-10. 2. Radiology. Spinal TB may be osseous or nonosseous. Imaging in children with spinal tuberculosis: a comparison of radiography, computed tomography and magnetic resonance imaging. Spinal tuberculosis is … There is usually a slow collapse of one or usually more vertebral bodies, which spreads underneath the longitudinal ligaments. Spinal tuberculosis: atypical observations at MR imaging. Tuberculous spinal infections are most often encountered in the lower thoracic or upper lumbar spine, although any spinal segment may be involved. Rajendra Kumar4, Sowmya Jagadish5, Pradeep Hagalahalli Nagarajegowda6, Ashwin Raghavendra7 1 Resident, 2Assistant Professor, 3Professor, … (A and B) Axial CT scan shows destruction of laminae and spinous process. 27.1 ). This case explores challenges in the diagnosis of spinal TB. The most vulnerable infection site for pediatric tuberculosis is the respiratory system, which accounts for about 47%. Fundamentals of diagnostic radiology. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Central Nervous System–Immune Reconstitution Inflammatory Syndrome, Recurrent Suppurative Thyroiditis Due to Piriform Sinus Fistula, Neuroradiology: Spectrum and Evolution of Disease. Both modalities are useful 15. Tuberculous spondylitis is one of the more common infections of spine in countries where TB is prevalent. Spinal tuberculosis accounts for around 2% of all cases of tuberculosis and around 15% of extrapulmonary tuberculosis cases . Thammaroj J, Thammaroj KA, Thammaroj SK, Thammaroj. 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. 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. DNA analysis has identified TB strains from bone biopsies of ancient Egyptian mummies, making it one of the oldest known communicable diseases. Medline, Google Scholar; 52 Modic MT, Feiglin DH, Piraino DW, et al. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Tuberculosis from head to toe. Tuberculosis of the spine: imaging features. 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. Lippincott Williams & Wilkins. It manifests secondary to extension through hematogenous route. Allen EH, Cosgrove D, Millard FJC. tuberculosis of spine 1. 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. DIFFERENCES OF MRI FEATURES BETWEEN TUBERCULOUS AND BACTERIAL SPONDYLITIS IN A TB-ENDEMIC AREA. Vertebral collapse is a common late-stage complication. Other associated features may include: As with other extrapulmonary TB, the chest film may be unrevealing (no pulmonary lesions seen in up to 50% of cases), with the source being a primary lung lesion that is clinically silent. The spine is involved due to hematogenous spread via the venous plexus of Batson 2. 3. 1. Objectives: A review of literature on the epidemiology, diagnosis, and management of spinal tuberculosis (TB). Laur O, Mandell JC, Titelbaum DS, Cho C, Smith SE, Khurana B. (2015) The Southeast Asian journal of tropical medicine and public health. Classically, spinal tuberculosis is thought to begin in the anteriorjinferior portion of the vertebral body [6, 7]. Tuberculosis of spine 1. Spinal TB patients typically present with back pain but other constitutional or pulmonary symptoms may be absent, rendering the diagnosis difficult. 1993; 189:489-493. 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. The spine is the most frequent location of musculoskeletal tuberculosis, and commonly related symptoms are back pain and lower limb weakness/paraplegia. It causes a kind of tuberculous arthritis of the intervertebral joints. Dähnert W. Radiology review manual. Extrapulmonary tuberculosis (TB) is uncommon but not rare. 27 (5): 1255-73. Imaging revealed ost… respond well to simple decompres- tension.