MRI is The Gold Standard Investigation For Early Detection, Extent of Involvement and Management of Patient in Pott’s Spine

Abstract

Introduction: Tuberculosis is increasing in the developing countries and re-emerging in the developed ones because of overcrowding and increase in of population. Spinal TB is the most clinically important form of extra-pulmonary tuberculosis, as it may produce serious neurological sequel due to compression of spinal cord by its excessive spread and involvement of spinal canal as a result of the disease itself, as well as the resultant deformity. Early recognition and prompt treatment are therefore necessary to minimize residual spinal deformity and or permanent neurological deficit. This retrospective study lightens and correlates the image morphology of spinal TB on MRI. Materials and methods: The study was done from January 2015 to June 2015 on 70 patients diagnosed with Tuberculosis of spine. MRI of spine was carried out in all the patients. MRI was done using a 1.5 tesla Philips system. MRI features were observed on T1W, T2W, Short tau inversion recovery (STIR) and post contrast (gadolinium) T1W sequences with sections in sagittal, coronal and axial planes. Results: This study showed that the most common clinical feature was back pain followed by deformity with most patients being afebrile. Most common vertebrae involved were dorsal followed by lumbar and the cervical with sacral being the least involved. Central type of vertebral lesion was common than paradiscal and rarely it involves posterior elements and inter vertebral disc. As compared to the other modalities soft tissue involvement, extent of lesion, type of lesion and Inter vertebral disc involvement are better visualised on MRI. Conclusion: MRI offers excellent visualization of the bone and soft tissue components of spinal tuberculosis and helps to identify disease at distant asymptomatic sites (skip lesions) before and accurately as compare to other modalities. MR imaging clearly demonstrated the extent of soft tissue involvement and its effect on the thecal sac/cord and neural foramen. It helps in early diagnosis and therefore management.