Radiological features during and following treatment of spinal tuberculosis

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. 28 episodes occurred in 26 patients, of whom only two were Caucasian. All demonstrated good response to conventional chemotherapy. Soft-tissue masses increased in size for up to 1.5 months and took about 12 months to resolve. Bone destruction was seen in all cases and progressed in 70% of patients, whilst on treatment. There was loss of vertebral body height in 79%, which progressed for up to 14 months; any recovery of height was a very late feature. Sclerosis was seen at presentation in 52% and developed in most of the remaining patients within 5 months of instigating treatment. It progressed for up to 14 months and took, on average, 31 months to return to normal. Reduction in disc height was commonly seen and the vertebrae fused in three-quarters of those affected, the time of onset of fusion being very variable. To manage patients with spinal tuberculosis, an appreciation of the variability of radiological changes that can occur during treatment is necessary.

Imaging findings of Pott’s disease

“…The earliest findings are radiolucencies and the loss of definition of the plate margins [1,4,11,14,21,24]. The most common appearance consists of vertebral body destruction (predominantly anterior), loss of disk height, erosion of end plates, vertebral geodes, bone sequestration, sclerosis and paravertebral masses [1,2,10,13,21,23,25] (Fig. 2).…”

“…Changes in soft tissue masses, namely the progression of calcifiying debris, are useful for the follow-up. Ankylosis, which occurs in over 50 % of patients, is considered the surest evidence of healing [13].…”

“…The disease often involves two contiguous vertebral bodies with the intervening disk, but multilevel extension (three or more vertebrae) is not uncommon and characterizes the disease. In addition, single or multiple vertebral involvement preserved disk has been recognized [3,4,[10][11][12][13]19]. It remains unclear whether the multivertebral disease is a consequence of hematogenous dissemination or it is a direct subligamentous, paraspinal or subarachnoid spread disease [20], although subligamentous spread seems most likely [12].…”

A large tuberculosis abscess causing spinal cord compression of the cervico-thoracic region in a young child

“…The development of kyphosis is a well-recognised late complication; the abscess might extend into the retropharyngeal space and the mediastinum resulting in acute respiratory distress syndrome, airway compromise and arterial erosion [25]. Radiological images may initially suggest progression of disease, despite effective treatment, and are not usually helpful in monitoring response to therapy [26].…”

Pattern Of Spinal Tuberculosis At Liaquat University Hospital, Hyderabad/Jamshoro

“…Among these cases, serial radiography has been proved to be good tool to assess the progress of disease. [10][11] MRI is good detector of activity of TB spondylitis 12 and ultrasound of abdomen in the cases of paravertebral abscess. 13 This paper presents pattern of spinal tuberculosis presenting as paraplegia/paraparesis in our set up.…”