Type:
Educational Exhibit
Keywords:
MR, Bones, Neuroradiology spine, Musculoskeletal bone, Musculoskeletal spine, CT, Infection
Authors:
J. Kavanagh, R. Dunne, J. Keane, A. M. Mc Laughlin; Dublin/IE
DOI:
10.1594/ecr2011/C-1917
Background
TB Spondylitis is one of the oldest diseases of mankind having been found in Egyptian Mummies dated as far back as 4000BC.
Bone and Joint infection account for 10-35% of extrapulmonary TB but only 2% of overall TB worldwide.This ancient disease has experienced a recent resurgence most notably in the immunocompromised host and the development of multidrug resistant strains.
Prevalence is highest in Africa and lowest in The Americas but due to better transport links and increasing population TB is a global problem.
Fig.
References: The antiquity of tuberculosis in Hungary: the skeletal evidence Antónia MarcsikI,1; Erika MolnárI; László SzathmáryII
The vertebral bodies are vunerable to seeding from Primary TB bacillemia due to the consistent vascular supply throughout adulthood.
The Lower Thoracic and upper lumbar vertebrae are affected most commonly (80-90%),
cervical spine involvement being both rarer (10%) and causing more morbidity.Infection starts anteroinferiorly and spreads down behind the anterior or posterior ligaments to involve the adjacent vertebral body causing local bone destruction and abscess formation.
Fig.: Mycobacterium Tuberculosis
Back Pain,
fever and weight loss are the most common presenting symptoms but due to the indolent nature of the disease and low index of suspicion in developed countries,
diagnosis is often delayed. Intrathoracic disease can be absent in up to 50% of TB Spondylitis as well as false negative tuberculin skin test rates of up to 14%.
Because of this,Radiologists often make the diagnosis leading to prompt anti microbial therapy to prevent serious neurological consequences.
Once the diagnosis is made Radiologists are once again key in obtaining microbial evidence of TB infection using CT or Fluoroscopic guided procedures.