ECR 2018 / C-1897
The many faces of Spinal Tuberculosis - A Pictorial review
Congress: ECR 2018
Poster No.: C-1897
Type: Educational Exhibit
Keywords: CNS, Neuroradiology spine, MR, Diagnostic procedure, Infection
Authors: S. Patwari1, H. C. Chadaga2; 1Bangalore/IN, 2BANGALORE, KA/IN
DOI:10.1594/ecr2018/C-1897

Background

Spinal tuberculosis is one of the most common sites of extra-pulmonary tubercular infection. It is one of the oldest disease known to the mankind and even to this date, there is significant prevalence and morbidity of this condition in developing countries. 

 

 Predisposing factors

 

 

• Poverty

• Overcrowding

• Illiteracy

• Malnutrition

• Alcoholism

 

• Drug abuse

• Diabetes mellitus

• Immunosuppressive treatment

• HIV infection

FokI polymorphism in the vitamin-D receptor gene.

 

 

 

Pathogenesis of spinal involvement

  • Hematogenous spread of M. tuberculosis into the dense vasculature of cancellous bone of the vertebral bodies.
  • Pulmonary / GU TB as primary source.
  • Infection spreads either from arterial (Subchondral arterial arcade) or venous route (Batsons venous plexus)
  • In younger patients, the disk is primarily involved because it is more vascularized.
  • In old age, the disk is not primarily involved because of its age-related avascularity.

 

Clinical features

  • Local pain, tenderness, stiffness and spasm of the muscles.
  • Cold abscess, gibbus.
  • Slow and insidous progression.
  • Constitutional symptoms.
  • Neurologic deficits are common with involvement of thoracic and cervical regions. Left untreated, early neurologic involvement may progress to complete paraplegia or tetraplegia 1.

Most of the available literature review of spinal tuberculosis is being focused on vertebral and disc involvement. It can also primarily affect epidural space, meninges and spinal cord.

 

Fig. 1: Spectrum of spinal tuberculosis
References: Columbia Asia Referral Hospital - Bangalore/IN
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