Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Tuberculous Osteomyelitis


KEY FACTS

Terminology

  • Tuberculosis (TB); TB spondylitis (TS)

    • Extrapulmonary granulomatous infection of spine/adjacent tissues

    • Also known as Pott (Pott's) disease

Imaging

  • Gibbus vertebrae with relatively intact intervertebral discs, large paraspinal abscesses

  • Midthoracic or thoracolumbar > lumbar, cervical

  • Isolated posterior element involvement possible

  • MR best modality to evaluate extent of disease, assess response to treatment

    • Sagittal STIR or FSE T2 with fat saturation most sensitive for bone marrow edema, epidural involvement

    • T1 C+

      • –

        Marrow, subligamentous, discal, dural enhancement

      • –

        Diffusely enhancing soft tissue = phlegmon

      • –

        Ring-enhancing = abscess

Top Differential Diagnoses

  • Pyogenic spondylitis

    • Initial infection in subchondral bone

    • Intervertebral discs typically affected

  • Fungal spondylitis

  • Spinal metastases

    • Extraosseous epidural or paraspinal extension

    • Disc space preserved

  • Brucellar spondylitis

Pathology

  • Hematogenous or lymphatic spread

  • Initially in anterior vertebral body

    • Spread under longitudinal ligaments → other (often noncontiguous) vertebrae

Clinical Issues

  • Chronic back pain, focal tenderness, fever

  • Neurologic deficits common in TS

Sagittal graphic through lumbar spine depicts multifocal granulomatous osteomyelitis. Frank abscesses are present at L3-L4 disc space
and between spinous process of L2 and L3
.

Sagittal STIR MR in a patient with TB infection shows involvement of contiguous vertebral bodies, with subligamentous abscess spread and partial disc involvement
. Multiple focal bone lesions are present without adjacent disc involvement
.

Sagittal T1WI C+ FS MR demonstrates focal kyphosis at L2-L3, collapse of the disc space, avid vertebral body enhancement
, and ventral and dorsal paravertebral abscesses
. There are peripherally enhancing abscesses in the paraspinal soft tissues
, which exhibit hypointense rims
.

Coronal T1WI C+ FS MR shows TB osteomyelitis with L2 vertebra plana
. Psoas involvement with swelling and marked enhancement
is present. Inflammatory soft tissue surrounds the disc
.

TERMINOLOGY

Abbreviations

  • Tuberculous spondylitis (TS)

Definitions

  • Granulomatous infection of spine and adjacent soft tissue secondary to tuberculosis (TB)

IMAGING

General Features

  • Best diagnostic clue

    • Gibbus vertebrae with relatively intact intervertebral discs, large paraspinal abscesses

  • Location

    • Midthoracic or thoracolumbar > lumbar, cervical

    • Anterior vertebral body

    • Isolated posterior element involvement possible

    • Laminae > pedicles > spinous process > transverse process

  • Size

    • Multiple (non)contiguous vertebrae

  • Morphology

    • Vertebral collapse, gibbus deformity

    • ± destruction of intervertebral discs

    • Epidural soft tissue mass

    • Large dissecting paraspinal abscesses over considerable distance

    • TS has higher rate of psoas abscess and involvement of posterior elements compared to brucellar spondylitis

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here

Related Posts