Boruah Deb K, Gogoi Bidyut B, Prakash Arjun, Lal Navneet R, Hazarika Karuna, Borah Krishna K
Department of Radiodignosis, Tezpur Medical College & Hospital, Tezpur, Assam, India.
Department of Pathology, Assam Medical College & Hospital, Dibrugarh, Assam, India.
Acta Radiol. 2021 Aug;62(8):1035-1044. doi: 10.1177/0284185120948496. Epub 2020 Aug 16.
Isolated posterior spinal (element) tuberculosis (TB) is uncommon compared to classical anterior spinal or para-discal TB. Here, we report magnetic resonance imaging (MRI) findings of posterior spinal TB in 19 patients without involvement of the vertebral body and intervertebral disc.
To evaluate the MRI findings in isolated posterior spinal (element) TB.
Clinical and MRI data of 19 patients of isolated posterior spinal TB were retrospectively evaluated.
Of the 19 patients, group A comprised 4 (21%) patients with rapid onset lower limb weakness and pyramidal signs while group B comprised 15 (79%) patients without any neurological deficit. Lumbar vertebrae commonly affected 9 (47.4%) patients followed by dorsal vertebrae in 8 (42.1%) patients and cervical vertebrae in 2 (10.5%) patients. The pedicle was most commonly involved in 12 (63.2%) patients followed by the lamina in 11 (58%) patients, and spinous process and facet joint in 6 (31.6%) patients each. Extra-spinal inflammation/pyomyositis/paraspinal abscess was found in 13 (68.4%) patients followed by epidural abscess 3 (15.8%) patients and both extra spinal inflammation and epidural abscess in 3 (15.8%) patients (15.8%). Compressive cord myelopathy was observed in 4 (21%) patients, where three patients underwent emergency decompression laminectomy and the remaining 16 patients were treated conservatively with anti-tubercular therapy.
Initial diagnosis of isolated posterior element TB is challenging and requires a high index of suspicion. Early diagnosis of isolated posterior spinal TB is important as early treatment may be beneficial and decreases patient morbidity.
与典型的脊柱前路或椎间盘旁结核相比，孤立性脊柱后部（结构）结核并不常见。在此，我们报告19例未累及椎体和椎间盘的脊柱后部结核的磁共振成像（MRI）表现。
评估孤立性脊柱后部（结构）结核的MRI表现。
回顾性分析19例孤立性脊柱后部结核患者的临床和MRI资料。
19例患者中，A组包括4例（21%）起病迅速的下肢无力和锥体束征患者，B组包括15例（79%）无任何神经功能缺损的患者。腰椎最常受累，有9例（47.4%）患者，其次是胸椎，有8例（42.1%）患者，颈椎有2例（10.5%）患者。椎弓根最常受累，有12例（63.2%）患者，其次是椎板，有11例（58%）患者，棘突和小关节各有6例（31.6%）患者受累。13例（68.4%）患者发现椎体外炎症/脓性肌炎/椎旁脓肿，3例（15.8%）患者发现硬膜外脓肿，3例（15.8%）患者同时存在椎体外炎症和硬膜外脓肿。4例（21%）患者观察到脊髓受压性脊髓病，其中3例患者接受了急诊减压椎板切除术，其余16例患者接受抗结核保守治疗。
孤立性脊柱后部结构结核的初步诊断具有挑战性，需要高度怀疑。孤立性脊柱后部结核的早期诊断很重要，因为早期治疗可能有益并降低患者发病率。
