STUDY OF MRI MORPHOLOGY OF SPINAL TUBERCULOSIS

OBJECTIVE: To study the morphology of tuberculosis of spine on MRI. METHODS AND MATERIALS: A retrospective study was done in the department of Radiodiagnosis, PESIMSR, Kuppam.This study includes 37 patients with suspected Spinal Tuberculosis, who were referred to the department of Radiodiagnosis between 2019 Jan to 2021 July. Informed consent was taken from all the patients. This study was done on GE Signa Explorer 1.5 Tesla. RESULTS: A total of 37 cases were included in the study. Of these 37 cases, 31 were males and 6 were females. The most common age group involved was between 20-40 years, seen in 15 cases followed by 41-60 yrs seen in 14 cases and 61-90 yrs seen in 8 cases. Lumbar vertebrae were commonly affected accounting for 86% of total cases (32cases) followed by dorsal and cervical vertebrae accounting for 8% and 5 % respectively (3 and 2 cases respectively). Intervertebral disc involvement (Discitis) was most commonly seen in 32 cases followed by vertebral endplate involvement (27 cases) in our study. Prevertebral & paravertebral involvement were found in 20 and 23 cases respectively . In our study,19 cases had shown the involvement of posterior elements .Epidural soft tissue component was seen in 22 cases. Psoas abscess and paraspinal involvement were seen in 9 and 8 cases respectively. CONCLUSION: MRI helps in the early assessment of the extent and severity of disease compared to X-ray and CT scan. It is valuable in detecting early marrow changes, intervertebral disc involvement, extradural abscess and cord compression.

A CASE OF SPINAL TUBERCULOSIS MISEVALUATED AS INTESTINAL OBSTRUCTION

Tuberculosis of spine (Pott's disease) is a frequently encountered extra pulmonary form of tuberculosis and is the most dangerous form . We report a case of spinal tuberculosis which present with clinical features of intestinal obstruction. A 45 1 year old male patient came to general surgery out patient department with chief complaints of pain abdomen since two weeks, constipation since two weeks and distension of abdomen since 10 days. History of fever present since 2 months low grade on and off. Case was evaluated with X ray erect abdomen, colonoscopy, CT abdomen which showing features of tuberculosis of spine. Patients of tuberculosis of spine can be asymptomatic and sometimes diagnosis is made incidentally during the course of evaluation for other symptoms

Extramedullary myeloid sarcoma mimicking tuberculosis of spine: A case report and literature review

Background: A definitive diagnosis of spinal tuberculosis (TB) remains challenging. The “gold standard” is to obtain histopathological confirmation of the lesion. This analysis highlights how to avoid missing the diagnosis of an extramedullary myeloid sarcoma (EMS) versus TB. Case Description: A 25-year-old male presented with paraparesis. Although this was first attributed to TB spondylodiscitis, a PET-CT and reevaluation of the biopsy specimen both confirmed the diagnosis of an EMS. Conclusion: Nontubercular spinal disease should be suspected when a patient deteriorates despite the institution of antitubercular therapy for a reasonable duration. Further, microbiological and/or pathological confirmation is warranted to direct appropriate treatment and differentiate spinal TB from other entities as, in this case, an EMS.

TO STUDY THE FUNCTIONAL AND THE RADIOLOGICAL OUTCOME OF TUBERCULOSIS OF SPINE OPERATED BY POSTERIOR APPROACH.

Background: Tuberculosis is ubiquitous in distribution. Globally, nearly 30 million people suffer from tuberculosis. 3 million deaths occur due to tuberculosis per year. India has burden of 6 million cases. Of these 1-3% constitutes skeletal system involvement. Methods: The present study included prospective cases of tuberculosis of dorsal and lumbar spine admitted and operated at Indira Gandhi Medical College, Shimla between May 2017 to May 2018 and retrospective patients who have been operated before May 2017. Results: There was improvement from preoperative kyphotic angle to postoperative kyphotic angle and improvement in kyphotic angle as a significant difference less than 0.05 (p value is 0.01). Conclusion: At the end of our study, we concluded that good sagittal balance along with good fusion of the vertebrae leads to better functional outcome in patients. Keywords: Spine, TB, Kyphotic angle.

It’s Never Too Late: Neurological Outcome of Delayed Decompression in Tuberculosis of Spine

Study Design: Retrospective observational study. Objective: To study the neurological recovery in patients with progressive neurological deficit undergoing delayed decompression and fixation in tuberculosis of spine. Methods: Retrospective analysis of 50 cases with thoracolumbar tuberculosis of spine, undergoing posterior decompression and instrumentation was done. Parameters like time interval between appearance of neurological deficit to decompression surgery, maximal spinal cord compression, neurology on admission, presence of drug resistance, and number of vertebrae involved were evaluated. The subjects were divided into 2 groups depending on neurological improvement measured with LEMS (Lower Extremity Motor Score) at the end of 1-year follow-up. Results: The mean LEMS score on admission was 27.72 (SD 12.88), which improved to 40.80 (SD 10.46) at the end of 1 year ( P < .001). A total of 26 (52%) subjects were categorized into “Satisfactory” outcome (LEMS >10) group and remaining 24 subjects formed the “nonsatisfactory” outcome group. The median time interval between the appearance of neurological deficit and decompression surgery was 23.50 days in the satisfactory group and 29.50 days ( P = .110) in the nonsatisfactory group. Maximal spinal cord compression was 0.370 in satisfactory group and 0.357 in nonsatisfactory group ( P = .754). The mean preoperative LEMS score was 34.62 in the satisfactory outcome group while that in the nonsatisfactory outcome group was 20.25 ( P < .001). Conclusion: There is significant scope for neurological improvement even after delayed decompression and fixation in cases of tuberculosis of spine with progressive neurological deficits. Preoperative neurological status was found to be the most significant determinant of postoperative neurological outcome.

Pott’s Spine with Tubercular Meningitis and Primary Optic Atrophy: An Enigma with a Rare Cautionary Tale

Tuberculosis of spine, known as Pott’s spine, is a significant health risk. Misdiagnosis or delayed diagnosis with lack of timely interventions lead to serious neurological complications and is associated with morbidity and mortality. We present a case of Pott’s spine who developed tubercular meningitis with decreased vision due to primary optic atrophy, to highlight the significance of thorough clinical and neuroradiological workup with instillation of prompt antitubercular therapy in patients of central nervous system tuberculosis (CNS TB). This association of Pott’s spine with decreased vision secondary to primary optic atrophy due to tubercular involvement of the second cranial nerve is very rare. Here, associated risk factors, varied clinical presentations, complications, and treatment of CNS TB are reviewed.