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Role of whole spine MRI in detection of noncontiguous multiple level spinal tuberculosis 2012

General Spine

Mohammed Azfar, Siddiqui, M.B.B.S., M.D.
Ibne, Ahmad, M.B.B.S., M.D., Non ASSR Member
Ekram, Ullah, M.B.B.S., M.D., Non ASSR Member
Syed Amjad Ali, Rizvi, M.B.B.S., M.S., Non ASSR Member

Paper/Non-Mentor

Purpose

Identification of noncontiguous multiple level spinal tuberculosis (NMLST), symptomatic or not, is important because of its impact on surgical management. Most centers do not perform routine whole spine MRI and reported incidence of NMLST varies from 1.1% to 10%. A higher incidence is expected if whole spine MRI is performed routinely. The purpose of present study is to evaluate the role of whole spine MRI in detection of NMLST.

Methods & Materials

MRI findings of 100 patients of infectious spondylitis that presented to our center over 2 years were reviewed retrospectively. 33 patients, who fulfilled the inclusion criteria, consisting of availability of whole spine MRI and confirmation of vertebral tuberculosis by histology, were included in final analysis. Diagnosis of NMLST was considered when other vertebral lesions were identified in addition to the primary vertebral disease separated by at least 1 normal spinal segment. Primary site was defined as the site for which the patient had been referred for MRI.

Results

NMLST was identified in 13 out 33 patients investigated using whole spine MRI. The incidence was 39.4% significantly higher than earlier reports where whole spine MRI was not routinely performed. Lumbar spine was involved in 9 patients, 8 patients had thoracic spine involvement, 6 patients had cervical spine involvement, and 1 patient had sacral involvement. Combined thoracic and lumbar spine involvement occurred in 7 patients, 5 patients had combined cervical spine and lumbar spine involvement, while 1 patient had involvement of the cervical and sacral spine. 8 of the 13 patients were asymptomatic at sites additional to their primary site of disease.

Conclusion

Tubercular spondylitis may affect the spine at multiple noncontiguous sites more than 50% of additional affected noncontiguous sites remaining asymptomatic. Although routine whole spine MRI using all recommended sequences is not cost effective and hence not feasible, we recommend whole spine screening using sagittal STIR or fat suppressed T2W fast spin echo sequence in all patients with suspected spinal infection.

References/Financial Disclosures

Nothing to disclose