Spinal tuberculosis: magnetic resonance imaging and neurological impairment

Retrospective descriptive study.

To evaluate the preoperative magnetic resonance imaging (MRI) findings in spinal tuberculosis and identify features that correlate with the neurologic status and outcome.

MRI plays an important role in the diagnosis of spinal tuberculosis with a high specificity and sensitivity. It allows demonstration of bony, soft tissue and neural pathology; however, the clinical correlation is not clear.

MRI scans of 82 consecutively managed spinal tuberculosis patients over a 4-year period were studied. Data including age, gender, human immunodeficiency virus status, neurologic status were reviewed. This was correlated with preoperative MRI findings including level of involvement, percentage of vertebral body destruction, kyphotic angle, soft tissue involvement, cord size, and cord signal changes.

Fifty-two percent of patients presented in a nonambulatory state, 21% mild neurologic deficit, and 27% were intact. Of those with neurologic deficit, significant recovery occurred in 92%, with 74% improving from nonambulatory to ambulatory status. The patients ambulant at presentation had a larger cord dimension than those who were not ambulatory. Cerebrospinal fluid persisting anterior to the cord at the apex of the deformity showed a trend to residual neurologic function. There was no significant correlation found between ambulatory status and the presence of an epidural abscess, kyphotic angle, or vertebral body destruction. There was no evidence of myelomalacia on the MRI scans, but cord signal changes on T2 images were present in 94% of patients presenting with neurologic deficit.

There is correlation between residual cord size, cerebrospinal fluid remaining anterior to the cord, presence of cord signal changes in the T2-weighted images, and neurologic deficit; however, none were predictive of outcome. There was no significant correlation found between ambulatory status and the presence of an epidural abscess, kyphotic angle, or vertebral body destruction.