Deb K Boruah1, Bidyut B Gogoi2, Arjun Prakash3, Navneet R Lal4, Karuna Hazarika1, Krishna K Borah1. 1. Department of Radiodignosis, Tezpur Medical College & Hospital, Tezpur, Assam, India. 2. Department of Pathology, Assam Medical College & Hospital, Dibrugarh, Assam, India. 3. Department of Radiodiagnosis, Bangalore Medical College, Karnataka, India. 4. Department of Radiodignosis, Assam Medical College & Hospital, Dibrugarh, Assam, India.
Abstract
BACKGROUND: Isolated posterior spinal (element) tuberculosis (TB) is uncommon compared to classical anterior spinal or para-discal TB. Here, we report magnetic resonance imaging (MRI) findings of posterior spinal TB in 19 patients without involvement of the vertebral body and intervertebral disc. PURPOSE: To evaluate the MRI findings in isolated posterior spinal (element) TB. MATERIAL AND METHODS: Clinical and MRI data of 19 patients of isolated posterior spinal TB were retrospectively evaluated. RESULTS: Of the 19 patients, group A comprised 4 (21%) patients with rapid onset lower limb weakness and pyramidal signs while group B comprised 15 (79%) patients without any neurological deficit. Lumbar vertebrae commonly affected 9 (47.4%) patients followed by dorsal vertebrae in 8 (42.1%) patients and cervical vertebrae in 2 (10.5%) patients. The pedicle was most commonly involved in 12 (63.2%) patients followed by the lamina in 11 (58%) patients, and spinous process and facet joint in 6 (31.6%) patients each. Extra-spinal inflammation/pyomyositis/paraspinal abscess was found in 13 (68.4%) patients followed by epidural abscess 3 (15.8%) patients and both extra spinal inflammation and epidural abscess in 3 (15.8%) patients (15.8%). Compressive cord myelopathy was observed in 4 (21%) patients, where three patients underwent emergency decompression laminectomy and the remaining 16 patients were treated conservatively with anti-tubercular therapy. CONCLUSION: Initial diagnosis of isolated posterior element TB is challenging and requires a high index of suspicion. Early diagnosis of isolated posterior spinal TB is important as early treatment may be beneficial and decreases patient morbidity.
BACKGROUND: Isolated posterior spinal (element) tuberculosis (TB) is uncommon compared to classical anterior spinal or para-discal TB. Here, we report magnetic resonance imaging (MRI) findings of posterior spinal TB in 19 patients without involvement of the vertebral body and intervertebral disc. PURPOSE: To evaluate the MRI findings in isolated posterior spinal (element) TB. MATERIAL AND METHODS: Clinical and MRI data of 19 patients of isolated posterior spinal TB were retrospectively evaluated. RESULTS: Of the 19 patients, group A comprised 4 (21%) patients with rapid onset lower limb weakness and pyramidal signs while group B comprised 15 (79%) patients without any neurological deficit. Lumbar vertebrae commonly affected 9 (47.4%) patients followed by dorsal vertebrae in 8 (42.1%) patients and cervical vertebrae in 2 (10.5%) patients. The pedicle was most commonly involved in 12 (63.2%) patients followed by the lamina in 11 (58%) patients, and spinous process and facet joint in 6 (31.6%) patients each. Extra-spinal inflammation/pyomyositis/paraspinal abscess was found in 13 (68.4%) patients followed by epidural abscess 3 (15.8%) patients and both extra spinal inflammation and epidural abscess in 3 (15.8%) patients (15.8%). Compressive cord myelopathy was observed in 4 (21%) patients, where three patients underwent emergency decompression laminectomy and the remaining 16 patients were treated conservatively with anti-tubercular therapy. CONCLUSION: Initial diagnosis of isolated posterior element TB is challenging and requires a high index of suspicion. Early diagnosis of isolated posterior spinal TB is important as early treatment may be beneficial and decreases patient morbidity.
Entities:
Keywords:
Magnetic resonance imaging; pain; spinal cord