MRI in spinal tuberculosis: Its use in early diagnosis and initiation of anti-tubercular therapy

Abstract

Objective: With high incidence and prevalence of spinal tuberculosis in developing countries like India MRI can be used for early detection of spinal tuberculosis and can serve as a basis for starting anti tubercular therapy without waiting for definitive confirmation in the form of bacteriological detection microscopically or in culture and without the use of invasive procedures like biopsy for histo-pathological diagnosis. Aims and objectives: To study the role of MRI in early detection and treatment of spinal tuberculosis Materials and methods 94 patients of spinal tuberculosis were diagnosed on history, clinical examination. Lab-investigations, X-ray spine and MRI spine. 2 patients were lost to follow-up and were thus excluded from the study. All the patients were put on ATT. Patients were followed for almost 9 to 12months at monthly intervals for first 6 months and thereafter every 3 monthly. At each follow-up patients were evaluated for pain relief, subsidence of fever, return of appetite, neurological recovery and lastly return to work. Results: Inter-vertebral disc space reduction, vertebral end plate erosions, Para-spinal collection (psoas abscess), anterior body wedge collapse cord compression, complete vertebral destruction were the consistent findings seen in our patients suggesting tubercular spondylitis. 92 (97.8%) patients responded to anti tubercular therapy with pain relief, absence of fever, improvement in appetite and neurological recovery and completely returned to work. 2 patients were lost to follow up. Conclusion: MRI spine can be used as a tool for early detection of tuberculosis spine and for empirical treatment way long before bacteriological diagnosis is made and thus can act a basis for starting ATT without definitive confirmation.