Chandrasekhar Yandrapati Bala Venkata Krishna, Rajesh Alugolu, Purohit Anirrudh Kumar, Rani Yarralgadda Jyotsna
Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India.
J Neurosci Rural Pract. 2013 Apr;4(2):122-8. doi: 10.4103/0976-3147.112733.
There exists a lot of ambiguity in the preoperative diagnosis of the various vertebral lesions. Mostly in these patients tuberculosis of spine (TB) is suspected due to endemicity of the disease in the Indian subcontinent. However, no definite guidelines are available to diagnose tuberculous (TB) vertebral lesions in the current literature.
This prospective study was conducted in the Department of Neurosurgery, Nizam's Institute of Medical Sciences, from August 2009 to March 2012.
To formulate non invasive methods to diagnose tuberculous vertebral lesions confidently so that the dependency on histopathologic diagnosis can be reduced.
Spinal MRI images of 45 patients suspected of having tuberculosis aetiology were included in the study prospectively.
A total of 64 patients were analysed and 19 patients were excluded due to lack of regular follow up or histological proof. The patients were divided into two groups; those with TB of the spine and those with some other condition affecting the spine (non TB spine) based on the final diagnosis. Of the 45 patients males were 30 (66.6%) and females were 15 (33.3%). There was no significant difference in the mean age of presentation. For TB patients this was 41 ± 15.56 years and in Non TB was 43 ± 18.27 years. All patients presented with backache in either group. There was epiphyseal involvement (100%), disc height reduction (71.42%) and pedicle destruction (42.82%) in plain X-rays in the TB group. Lumbar spine was the most common affected region in our study (26.31% in non TB and 34.6% in TB group of patients). Significant P value and the Odds Ratio was found for T1 hypo intensity, T2 hyper intensity, epiphyseal involvement, disc involvement, pedicle involvement, anterior subligamentous extension, paraspinal extension and no spinous process involvement (eight parameters). The eight parameters were tested among both the groups and it was noted that scores ≥ 6 favored a tuberculous pathology whereas ≤4 were suggestive of non tuberculous etiology.
The eight point MRI criteria of the vertebral lesions are likely to enhance the diagnostic ability of tuberculous and non tuberculous pathologies thereby reducing the dependency on histopathologic diagnosis or invasive method for early initiation of therapy.
各种脊柱病变的术前诊断存在诸多不明确之处。在印度次大陆，由于脊柱结核（TB）这种疾病的地方性流行，这些患者大多被怀疑患有脊柱结核。然而，当前文献中尚无明确的指南用于诊断结核性脊柱病变。
这项前瞻性研究于2009年8月至2012年3月在尼扎姆医学科学研究所神经外科进行。
制定可靠的非侵入性方法来诊断结核性脊柱病变，从而减少对组织病理学诊断的依赖。
前瞻性纳入45例疑似结核病因的患者的脊柱MRI图像进行研究。
共分析64例患者，19例因缺乏定期随访或组织学证据被排除。根据最终诊断，患者被分为两组：脊柱结核患者和患有其他影响脊柱疾病（非脊柱结核）的患者。45例患者中男性30例（66.6%），女性15例（33.3%）。两组患者的平均就诊年龄无显著差异。脊柱结核患者平均年龄为41±15.56岁，非脊柱结核患者平均年龄为43±18.27岁。两组患者均以背痛就诊。脊柱结核组X线平片显示骨骺受累（100%）、椎间盘高度降低（71.42%）和椎弓根破坏（42.82%）。腰椎是本研究中最常受累的部位（非脊柱结核组患者中占26.31%，脊柱结核组患者中占34.6%）。发现T1低信号、T2高信号、骨骺受累、椎间盘受累、椎弓根受累、前纵韧带下延伸、椎旁延伸和无棘突受累（八个参数）具有显著的P值和优势比。在两组中对这八个参数进行了测试，结果显示评分≥6提示为结核性病变，而≤4提示为非结核性病因。
脊柱病变的八点MRI标准可能会提高结核性和非结核性病变的诊断能力，从而减少对组织病理学诊断或侵入性方法的依赖，以便早期开始治疗。
