Non-osseous Tubercular Lesions of Spinal and Paraspinal Region-Evaluation by MRI

• Main Authors: Jaiganesh Sivalingam, Anil Kumar, Konduru Varadarajulu Rajasekhar
• Format: Article
• Language: English
• Published: JCDR Research and Publications Private Limited 2019-02-01
• Series: Journal of Clinical and Diagnostic Research
• Subjects: pott’s spine; spondylitis; tuberculosis
• Online Access: https://www.jcdr.net/articles/PDF/12552/40125_CE[Ra1]_F(AC)_PF1(AJ_SL)_PN(SL).pdf

Introduction: Spinal tuberculosis is very common in developing countries like India and it has a wide spectrum of appearance on MRI ranging from simple marrow oedema to complete vertebral body collapse. Early diagnosis and intervention at initial period provide very good prognosis and very less morbidity. Aim: To demonstrate rare MRI features in cases of tubercular lesions in the spinal and paraspinal region without involvement of osseous components of the spine. Materials and Methods: This was a prospective descriptive study conducted in a Tertiary Care Hospital in India from June 2011 to December 2014 based on the MRI findings in patients with Tuberculosis of Spinal and Paraspinal region. Total 529 cases of tubercular spinal lesions were diagnosed. Out of which only 43 patients showed only extraosseous spinal and paraspinal lesions, these were included in the study. Patients with involvement of bony components or typical MRI pictures such as involvement of intervertebral disc and adjacent vertebral bodies were not included in the study. The diagnosis was confirmed by cytology, histopathology, serology and corroborative findings. Results: Various extraosseous changes involving spinal and paraspinal components in case of tubercular lesions, such as 27 cases of Paraspinal soft tissue lesions (62.8%)-Abscesses and Granulation tissue, 10 cases of Extradural and Intradural soft tissue component (23.2%), 4 cases of arachnoiditis (9.3%), 2 cases of Intramedullary Tuberculoma (4.6%) and 1 case of Spinal Cord Abscess (2.3%) were observed and the observed findings were tabulated. Conclusion: On MRI, Spinal Tuberculosis may have wide spectrum of appearance. Involvement of soft tissue without affecting the spinal bony component is quite rare. Hence, the possibility of tuberculosis should be considered even when the bony components are spared. Timely diagnosis and intervention will reduce the morbidity and avoids the complications. MRI plays key role in follow-up of patients to assess the response to treatment.