Vertebral Involvement Research Articles

Osteoporotic vertebral fractures: predictive factors for conservative treatment failure. A systematic review.

To analyze clinical, radiographic and magnetic resonance findings that might predict risk of complications and conservative treatment failure of osteoporotic vertebral fractures. The authors conducted a systematic review of observational studies, collecting data on osteoporotic vertebral fracture and complications like vertebral collapse, kyphosis, pseudoarthrosis, and neurologic deficit. MeSH items such as 'spinal fracture/radiology,' 'spinal fracture/complications,' 'spinal fracture/diagnosis' were used. PRISMA statement criteria were applied, and the risk of bias was classified as low, medium, high, following the Newcastle-Ottawa Quality Assessment Scale (NOS). Eleven cohort studies, either retrospective or prospective, met the eligibility criteria and were included in the review. Major risk factors that were statistically predictive of the following complications were as follows; (1) vertebral collapse: presence of intravertebral cleft, MR T1-WI 'total type fractures' and T2-WI 'hypointense-wide-type'. (2) Pseudoarthrosis (nonunion): middle-column damage, thoracolumbar vertebrae involvement, MR T2-WI confined high-intensity pattern and diffuse low intensity pattern. (3) Kyphotic deformity: thoracolumbar fracture and superior endplate fracture. (4) Neurologic impairment: a retropulsed bony fragment occupying more than 42% of the sagittal diameter of the spinal canal and a change of more than 15° in vertebral wedge angle on lateral dynamic radiography. Shape and level of the fracture were risk factors associated with the progression of collapse, pseudoarthrosis, kyphotic deformity and neurologic impairment. MRI findings were often related to the failure of conservative treatment. If prognosis can be predicted at the early fracture stage, more aggressive treatment options, rather than conservative ones, might be considered.

The Effect of Vertebral Endplate Involvement on Spine Radiosurgery Outcomes

This study sought to evaluate local and adjacent vertebral body outcomes in patients treated with spine radiosurgery. The relationship between vertebral endplate involvement and clinical outcomes was also analyzed. 156 patients (361 spine segments and 452 endplates) with spine tumors treated with stereotactic body radiotherapy from January 2010 to December 2015 were retrospectively reviewed. Initial treatment fields were based on ASTRO consensus guidelines. Cox regression analysis was performed to search for possible predicting factors for time to local and adjacent vertebral body failure. Factors included endplate involvement, extraspinal extension of metastatic disease, fraction number, tumor histology (radioresistant vs. radiosensitive), performance status and gender. Median patient age was 66 years (range, 17-91 years), median follow-up was 7 months (range, 1-61 months). 16.8% of endplates reviewed had tumor involvement and fracture rate after radiosurgery was 7.5%. The overall local control rate was 85% at 6 months and 76% at 1 year. 57% of vertebral bodies received single fraction treatment (13-20 Gy), while 34% received three fraction treatment (range, 16-27 Gy), and 9% received five fraction treatment (25-40 Gy). Single fraction treatment was superior in terms of local control (p<0.05). Endplate involvement was significantly associated with adjacent vertebral body involvement (p<.05) and had a positive predictive value of 26%, and a mean time to adjacent failure of 23.5 months. Radiosurgery can achieve durable radiologic control of metastatic spinal disease with minimal toxicity. Endplate involvement may serve as a positive predictor for adjacent tumor spread.

CERVICAL BRUCELLOSIS, WITH OR WITHOUT BONE INJURY

Brucellosis is a zoonotic infectious systemic, endemic in Albania, which is accompanied by multi-organ involvement. A common complication is also the vertebral affection. Manifestation in the lower lumbar spine is frequently seen, while cervical involvement is more rare. Diagnose of vertebral involvement is difficult because of non-specific clinical symptoms. We present two cases of cervical brucellosis, with various cervical injuries. Spondylodiscitis with epidural abscess were the cervical manifestation in the first patient, which is very rare and a serious complication and the second patient had epidural involvement without spondylodiscitis. The Rose Bengal, Wright test, ELISA were positive for both patients. The cervical injury was confirmed with MRI exams. After prolonged combination therapy with cervical immobilization, the follow up evaluation demonstrated resolution of the cervical injury. Because vertebral destruction is in the base of this complication, early diagnosis of vertebral brucellosis is important to prevent serious morbidity, if diagnosis and treatment are delayed. Standard Brucella tube agglutination (Wright) test is the primary test and should be performed as a first step in the differential diagnosis of spondylodiscitis. An MRI is recommended for early diagnosis of spinal involvement. Medically treatment of cervical brucellosis has a good prognosis with early diagnosis.

Spinal Implants Can Be Retained in Patients with Deep Spine Infection: A Cohort Study: 深層脊椎感染的患者可以保留脊柱植入物 - 一項隊列研究

Background/PurposeIt is unclear whether implant removal is necessary when deep spine infection of spinal instrumentation occurs. This study compares mortality, relapse, and reoperation rates between such patients with and without removal of spine implants. MethodsA total of 20 patients were retrospectively reviewed. Baseline characteristics of the implant removal and nonremoval groups were compared. Outcome measures between groups were compared using multivariable logistic regression and predictors of each outcome identified. ResultsThere were no significant differences in mortality, relapse, or reoperation rates between groups. Multiple vertebral level involvement was common (85%), and the L4 (30%) and L5 (35%) levels were most commonly involved. The majority of patients had osteomyelitis/spondylodiscitis (50%) and Staphylococcus aureus infections (60%). Thoracic spine infection was associated with relapse (odds ratio = 1.26) and reoperation (odds ratio = 1.101). ConclusionImplant removal is not always necessary in cases of deep spine infection as retention of implants is not associated with higher mortality, relapse, or reoperation rates.

Spinal Hydatid Cyst Disease.

A hydatic cyst (HC) is a zoonotic infection affecting the liver and lungs, with rare spinal involvement. We discuss the long-term results in 8 patients with spinal HC who were monitored at our clinic for 7 to 15 years. The demographic data and clinicopathologic characteristics of 8 patients with spinal HC diagnosed between 2000 and 2016 were evaluated for their contribution to recurrence, and the long-term follow-up results were examined. Four male and 4 female patients with a median age of 30.75 years (range, 17-45 years) at the first surgery were included. Infections were localized in the thoracic (3), thoracolumbar (1), lumbar (1), sacral (1), cervicothoracic (1), and lumbosacral (1) regions. Two patients had secondary HCs that spread from another organ (lung and kidney). Patients underwent 2 to 5 surgeries during the study period, with an average follow-up time of 8.5 years (range, 7-15 years) after the first surgery. The surgical treatments included an anterior corpectomy and anterior plate for a patient with cervical localization and cystectomy for a patient with sacral localization; the other patients underwent cystectomy with corpectomy and stabilization with an anterior approach, cyst excision and laminectomy with a posterior approach, or additional posterior transpedicular screw stabilization. The patients were prescribed albendazole. Spinal HC treatment is difficult, particularly in patients with vertebral and paraspinal involvement, spinal instability, and recurrence. Long-term follow-up is critical, and patients require medical and surgical treatment, with regular clinical, radiologic, and serologic examinations. The cysts must be removed without rupture during surgery, and the surgical area must be irrigated with hypertonic saline solution to reduce the risk of recurrence.

Diagnosis and classification in MRI of brucellar spondylitis

ObjectiveTo explore the magnetic resonance imaging (MRI) features of patients with brucellar spondylitis and try to classify them depending on the MRI findings. Material and methods67 patients (male&female: 50&17) with brucellar spondylitis were recruited in this study. MRI examinations were performed in all patients. Firstly, MRI data were analyzed by two senior radiologists. Secondly, according to the imaging findings, patients were divided into different types. ResultsIn all 67 patients with spinal brucellosis, 5 cases only had paravertebral soft tissue involved, 62 cases showed abnormal signal in single or multiple adjacent vertebrae. Thirty-five patients focused on the L4 vertebral involvement. 18 cases had appendage involvement. 27 cases hand intervertebral disc narrowing and cystic signal. Paravertebral, epidural and psoas abscesses were detected in 35, 20 and 8 cases.Patients were grouped according to MRI findings. The vertebral inflammatory type was the most frequently type with the rate of 35.8%, followed by discitis type 32.9%, adnexitis type 11.9%, paravertebral and psoas abscess type 11.9% and paravertebral soft tissue type 7.5%. ConclusionIt is not difficult to diagnose brucellar spondylitis in MRI findings based on clinical background and laboratory tests. According to the performance of MRI, five types can be classified.

Clinical characteristics, treatments, and outcomes of hematogenous pyogenic vertebral osteomyelitis, 12-year experience from a tertiary hospital in central Taiwan.

In Taiwan, studies about hematogenous pyogenic vertebral osteomyelitis (HPVO) are limited. We conducted a retrospective study to evaluate the clinical presentations, treatment, and outcomes of patients with the diagnosis of HPVO. This 12.5-year retrospective study included patients with a diagnosis of HPVO. Medical records of all HPVO patients were thoroughly reviewed and their clinical data were analyzed by the SPSS software. 414 HPVO cases were included and the mean age was 61.6±13.4 years. The mean duration of symptoms was 29±35.3 days and pain over the affected site was reported by most patients (86.0%). Gram-positive bacteria, especially Staphylococcus aureus (162/399=40.6%), were the main HPVO pathogens. Escherichia coli (42/399=10.5%) was the most common gram-negative isolate. Surgery was performed in 68.8% of cases and the mean duration of total antibiotic treatment was 104.7±77.7 days. All-cause mortality and recurrence rates were 6.3% and 18.8%, respectively. In multivariate analysis, polymicrobial infection (OR: 4.154, 95% CI: 1.039-16.604, p=0.044), multiple vertebral body involvement (OR: 2.202, 95% CI: 1.088-4.457, p=0.028), abscess formation treated with antibiotics alone (OR: 2.912, 95% CI: 1.064-7.966, p=0.037), and the duration of antimicrobial treatment less than 4 weeks (OR: 3.737, 95% CI: 1.195-11.683, p=0.023) were associated with HPVO recurrence. In Taiwan, HPVO mainly affected the elderly and S. aureus remained the most common HPVO pathogen. In patients with risk factors associated with HPVO recurrence, a longer duration (≥6 weeks) of antimicrobial therapy is suggested.

Non-Hodgkin's Lymphoma Presenting as an Isolated Vertebral Collapse

AbstractNon-Hodgkin's lymphoma (NHL) presenting as an isolated vertebral collapse is a very rare condition. We present a case of non-Hodgkin's lymphoma presenting as L3 vertebral body collapse on MRI. Isolated vertebral involvement was seen without evidence of any lesion elsewhere. Workup for systemic evidence of malignancy with contrast-enhanced CT of chest and abdomen did not reveal any other lesion. The patient was operated for L3 transpedicular decompression and L2–L4 pedicle screw rod fixation. Biopsy revealed diffuse large B cell lymphoma (DLBCL), NOS. Diagnosis was further confirmed by a postoperative PET scan, which showed multiple deposits in perinephric fat and retroperitoneal lymph nodes. Patient was treated with CHOP-based chemotherapy.

MR imaging findings of vertebral involvement in Gorham-Stout disease, generalized lymphatic anomaly, and kaposiform lymphangiomatosis.

To assess the MR imaging findings of vertebral involvement in Gorham-Stout disease (GSD), generalized lymphatic anomaly (GLA), and kaposiform lymphangiomatosis (KLA). Nine patients (three patients with GSD, three with GLA, and three with KLA) who underwent whole-spine MR examinations were included. MR findings of fatty marrow replacement and prolonged T1 and T2 lesions of the vertebrae were retrospectively assessed. Prolonged T1 and T2 lesions were defined as well-defined and round-, oval-, or geographic-shaped areas. Six patients [one (33%) patient with GSD, two (67%) with GLA, and three (100%) with KLA] showed both fatty marrow replacement and prolonged T1 and T2 lesions. Fatty marrow replacement was seen in the cervical spine of two (33%) patients, thoracic spine of six (100%), lumbar spine of six (100%), and sacral spine of two (33%). Prolonged T1 and T2 lesions were seen in the cervical spine of three (50%) patients, thoracic spine of three (50%), lumbar spine of six (100%), and sacral spine of three (50%). Both fatty marrow replacement and prolonged T1 and T2 lesions of the vertebrae could be observed in GSD, GLA, and KLA. The most commonly affected site was the lumbar spine, followed by the thoracic spine.

Spine stereotactic radiosurgery for metastatic sarcoma: patterns of failure and radiation treatment volume considerations.

OBJECTIVE Given the relatively lower radiosensitivity of sarcomas and the locally infiltrative patterns of spread, the authors sought to investigate spine stereotactic radiosurgery (SSRS) outcomes for metastatic sarcomas and to analyze patterns of failure. METHODS The records of 48 patients with 66 sarcoma spinal metastases consecutively treated with SSRS between 2002 and 2013 were reviewed. The Kaplan-Meier method was used to estimate rates of overall survival (OS) and local control (LC). Local recurrences were categorized as occurring infield (within the 95% isodose line [IDL]), marginally (between the 20% and 95% IDLs), or out of field. RESULTS Median follow-up time was 19 months (range 1-121 months), and median age was 53 years (range 17-85 years). The most commonly treated histology was leiomyosarcoma (42%). Approximately two-thirds of the patients were treated with definitive SSRS (44 [67%]) versus postoperatively (22 [33%]). The actuarial 1-year OS and LC rates were 67% and 81%, respectively. Eighteen patients had a local relapse, which was more significantly associated with postoperative SSRS (p = 0.04). On multivariate modeling, receipt of postoperative SSRS neared significance for poorer LC (p = 0.06, subhazard ratio [SHR] 2.33), while only 2 covariates emerged as significantly correlated with LC: 1) biological equivalent dose (BED) > 48 Gy (vs BED ≤ 48 Gy, p = 0.006, SHR 0.21) and 2) single vertebral body involvement (vs multiple bodies, p = 0.03, SHR 0.27). Of the 18 local recurrences, 14 (78%) occurred at the margin, and while the majority of these cases relapsed within the epidural space, 4 relapsed within the paraspinal soft tissue. In addition, 1 relapse occurred out of field. Finally, the most common acute toxicity was fatigue (15 cases), with few late toxicities (4 insufficiency fractures, 3 neuropathies). CONCLUSIONS For metastatic sarcomas, SSRS provides durable tumor control with minimal toxicity. High-dose single-fraction regimens offer optimal LC, and given the infiltrative nature of sarcomas, when paraspinal soft tissues are involved, larger treatment volumes may be warranted.

Dynamic contrast-enhanced MRI in the early diagnosis of brucella spondylitis

Objective To explore the value of dynamic contrast-enhanced (DCE). MRI in the early diagnosis of brucellosis spondylitis. Methods Fifty-six patients (24 female and 32 male) with Brucellosis with average age of (49±3) years were retrospectively analyzed. Inclusion criteria: The patients with clinically diagnosed brinell coli spondylitis, drops of serum agglutination test degree 1∶100>(++), Hu>red plate agglutination test (++), enzyme-linked immunosorbent assay to detect specific antibody IgG/IgM (+). Exclusion criteria: Pregnant and lactating women, patients with MRI examination contraindications and spinal tuberculosis, myeloma or other spinal disease, patients with the cervical, thoracic and lumbar 5 vertebral body involvement. The patients were classified into early lesion group and lesion group. Early lesion group was defined as low back pain less than a month, enzyme-linked immunosorbent assay positive IgM and negative IgG results, and no abnormality in conventional MR imaging, while lesion group was defined as low back pain for longer than 3 months, enzyme-linked immunosorbent assay positive IgG and negative IgM and marked lesion in conventional MR imaging. All the patients conducted with conventional MRI and DCE-MRI scan. The differences of the Ktrans, Kep, Ve and Vp between the vertebral lesions, early lesions of vertebral body and normal tissues were measured and compared. Results The values of Ktrans, Kep, Ve and Vp were significantly different between the vertebral lesions [(0.856±0.539) ml/min, (1.482±0.711) ml/min, 0.542±0.267, 0.034±0.017] and normal tissues [(0.315±0.298) ml/min, (0.713±0.548) ml/min, 0.358±0.259, 0.056±0.03] (all P 0.05). Conclusion DCE-MRI quantitative analysis plays a role in the early diagnosis of the brucella spondylitis. Key words: Spondylitis; Magnetic resonance imaging; Early diagnosis; Brucella

A Case Report of Paraplegic Pott’s Disease Exhibiting Cervical Vertebral Involvement

A Case Report of Paraplegic Pott’s Disease Exhibiting Cervical Vertebral Involvement

Long-term outcome of patients with solitary plasmacytoma treated with radiotherapy: A population-based, single-center study with median follow-up of 13.7years.

In this single-center, population-based, and retrospective study, we analyzed the outcome of 49 patients with solitary bone plasmacytoma (SBP) and 28 patients with solitary extramedullary plasmacytoma (SEP), all treated with radiotherapy. Laminectomy was performed in 18/30 SBP patients with vertebral involvement and tumour resection in 10 SEP patients. Overall survival and cause of death for each patient were compared to 5 sex-, age-, and residency-matched individuals from the normal population. Response (complete and partial) was achieved in 94% of SBP and 96% of SEP patients. Relapse rates were higher in SBP (65%) compared to patients with SEP (18%) (P<.01). Only one in-field relapse was identified for the whole series. Ten- and 15-year overall survival, progression free survival (PFS) and multiple myeloma free survival (MMFS) for patients with SBP were 60%/41%, 25%/17%, and 33%/33%. Corresponding values for patients with SEP were 67%/54%, 57%/44%, and 91%/91%. SBP patients had significantly shorter PFS and MMFS compared to SEP patients (P<.01 for both). Only two of the SEP patients developed multiple myeloma and no patient in the whole series progressed to multiple myeloma later than 10years after diagnosis. Unlike for SEP, the major cause of death among SBP patients was multiple myeloma (49%). Compared to matched normal population, no increased risk of death from secondary malignancies or cardiovascular disease was observed. Positive predictors in SBP patients were for overall survival age <60years, combined laminectomy and radiotherapy and radiotherapy dose >40 gray, for PFS tumour size <6cm and combined laminectomy and radiotherapy and for MMFS tumour size <6cm. Radiotherapy confers excellent local control in both SEP and SBP patients; however, the challenge is to prevent development of multiple myeloma in patients with SBP.

English

Spinal epidural abscess (SEA) is a rare but potentially devastating condition. Tuberculosis (TB) as the aetiology of epidural abscess especially without bony the involvement of vertebrae is uncommon. We present here, our experience with two cases where patient had TB SEA without bony involvement. Magnetic resonance imaging (MRI) provided imaging localization. Diagnosis was confirmed by mycobacterial culture and line probe assay. Both patients were managed by decompression and anti-TB treatment.

Musculoskeletal Tuberculosis.

Musculoskeletal tuberculosis (TB) accounts for approximately 10% of all extrapulmonary TB cases in the United States and is the third most common site of extrapulmonary TB after pleural and lymphatic disease. Vertebral involvement (tuberculous spondylitis, or Pott's disease) is the most common type of skeletal TB, accounting for about half of all cases of musculoskeletal TB. The presentation of musculoskeletal TB may be insidious over a long period and the diagnosis may be elusive and delayed, as TB may not be the initial consideration in the differential diagnosis. Concomitant pulmonary involvement may not be present, thus confusing the diagnosis even further. Early diagnosis of bone and joint disease is important to minimize the risk of deformity and enhance outcome. The introduction of newer imaging modalities, including MRI (imaging procedure of choice) and CT, has enhanced the diagnostic evaluation of patients with musculoskeletal TB and for directed biopsies of affected areas of the musculoskeletal system. Obtaining appropriate specimens for culture and other diagnostic tests is essential to establish a definitive diagnosis and recover M. tuberculosis for susceptibility testing. A total of 6 to 9 months of a rifampin-based regimen, like treatment of pulmonary TB, is recommended for the treatment of drug susceptible musculoskeletal disease. Randomized trials of tuberculous spondylitis have demonstrated that such regimens are efficacious. These data and those from the treatment of pulmonary TB have been extrapolated to form the basis of treatment regimen recommendations for other forms of musculoskeletal TB.

Abstract 099: Prevalence of Headaches in Patients with Fibromuscular Dysplasia: A Report from the US Registry for FMD

Introduction: Fibromuscular dysplasia (FMD) is a polyvasculopathy that may result in aneurysm or dissection in affected arterial beds. A common symptom of FMD is headache (HA). The purpose of this study is to describe and compare characteristics of FMD patients with (w/HA) and without headaches (wo/HA) in the current US Registry for FMD. Method: Data regarding demographics, family history, medical history, and vascular beds affected in patients with FMD were collected from the US Registry for FMD between 2009 and 2016. Patients with complete HA data were included, and data were compared between patients w/HA and wo/HA as reported at time of registry enrollment. Results: Of the 1,433 patients in the registry, 1,251 (87.3%) had complete HA data. Most were female (94.1%), with a mean age of 56.0±12.4. A history of HA was reported in 844 (67.5%) patients and 54.2% reported a HA at least weekly. No difference in gender distribution was seen between HA groups. Patients w/HA were younger at the time of FMD diagnosis (50.6±11.8 years v 58.0±13.8 years, p&lt;0.001) and were less likely to have a history of HTN (66.8% v 74.8%, p=0.004), hyperlipidemia (36.9% v 47.2%, p=0.004), or renal failure (2.6% v 5.7%, p=0.009). Patients w/HA were more likely to have a history of aneurysm or dissection in the extracranial carotid, intracranial, or vertebral arteries (aneurysm: 13.0% v 7.2% p=0.003; dissection: 25.1% v 8.3%, p&lt;0.001). No differences in extracranial carotid, intracranial, or vertebral FMD involvement between patients w/ and w/o HA were seen when those with history of aneurysm or dissection of those arteries were excluded (71.2% v 66.8%, p=0.20). Headache patients more often reported a history of depression (25.1% v 16.5%, p=0.01) and anxiety (28.3% v 18.0%, p=0.003). Conclusion: More than half of FMD patients experience HAs, most on an at least weekly basis. FMD patients with HA tended to be younger, and more likely to have extracranial carotid, intracranial, or vertebral disease as well as aneurysm and dissection. Depression and anxiety was also more common in FMD patients with HA. Further research is needed to classify the types of headaches being experienced as well as effective management strategies.

52 - Are the SINS and NOMS classifications useful in predicting the need for surgery in patients with metastatic vertebral body involvement?

52 - Are the SINS and NOMS classifications useful in predicting the need for surgery in patients with metastatic vertebral body involvement?

Ruptured intracranial vertebral artery dissecting aneurysms: An evaluation of prognostic factors of treatment outcome.

Objective Intracranial spontaneous vertebral artery dissecting aneurysms commonly occur in the third to fifth decades of life, and are mostly associated with hypertension. Patients present with intracranial haemorrhage or thromboembolic events. Patients who present with intracranial haemorrhage carry about a 70% risk of recurrent bleeding. Patients with a posterior-inferior cerebellar artery (PICA) or ipsilateral dominant vertebral artery involve selecting which parent vessel could not be sacrificed. Recent reconstructive techniques such as stent-assisted coiling embolisation and flow-diverting stents are effective treatments of choice. Methods Seventeen patients presented subarachnoid haemorrhage and nine patients with other symptoms. Sacrificing the parent vertebral artery was the first choice for surgical or endovascular methods. Endovascular reconstructive treatment by stent-assisted coiling embolisation was indicated in dissecting vertebral artery aneurysms with ipsilateral dominant vertebral artery or PICA involvement. Clinical outcomes were determined using the modified Rankin Score (mRS) at 90 days, with favourable outcomes defined as 0 to 2. Results Of the patients presenting with ruptured aneurysms, 11 (61.1%) had a good clinical outcome, with a mRS of 0-2. Favourable Hunt and Hess grading (65%), mild to moderate GCS (65%) and total occlusion of aneurysms after treatment (65%) were significantly good prognostic factors in patients with ruptured vertebral artery dissecting aneurysms. Conclusion Endovascular parent vessel sacrifice could be the first choice to treat a ruptured vertebral artery dissecting aneurysm. Stent-assisted coiling to preserve the patency of the parent artery and its branches is a promising treatment for vertebral artery dissections.

SC16.03 Radiotherapy for Sulcus Superior Tumors

SC16.03 Radiotherapy for Sulcus Superior Tumors

Magnetic resonance imaging findings of patients with suspected tuberculosis from a tertiary care centre in Sri Lanka

Spinal tuberculosis (TB) is a relatively common cause for spinal pathology in Sri Lanka and a common indication for magnetic resonance imaging (MRI). The objective of the study was to describe the MRI imaging pattern of spinal TB in a series of patients. One hundred and nine patients with clinically confirmed spinal tuberculosis who had undergone MRI scans at the National Hospital of Sri Lanka from 2012-2016 were included in the study. The commonest vertebral level of spinal TB involvement was at L4/5 level, followed by L5/S1 level. L5 vertebral body involvement was the commonest and L4 was second commonest. Single level involvement (68.8%) was commoner than multiple (31.2%) involvement or contiguous involvement. Wedging (24.8%), erosions (89%), end plate changes (96.3%), canal stenosis (77.1%), paravertebral collection (65.1%), prevertebral collection (39.4%), psoas abscess (23.9%) and epidural collection (45.9%) were noted. No significant difference was seen between females and males. Spinal tuberculosis commonly involves L4/5 level.