Clinical and radiological characteristics of parenchymal and meningeal spinal tuberculosis

Spinal tuberculosis is a rare condition that can result in significant neurological impairments. It is typically classified into two main types based on the anatomical involvement: parenchymal and meningeal. However, existing studies have not provided systematic reports that clarify the differences in aetiology, pathophysiological mechanisms, and clinical presentations between these two types.

This retrospective study includes 107 patients diagnosed with intracranial tuberculosis accompanied by spinal tuberculosis via magnetic resonance imaging (MRI) between May 2019 and May 2024 at our hospital. Patients are categorised into parenchymal and meningeal types based on radiological manifestations. Clinical symptoms, comorbidities, peripheral blood and cerebrospinal fluid laboratory indices, and MRI data are collected for both groups. Statistical analyses are performed using Chi-square tests, independent sample t-tests and non-parametric tests.

Parenchymal spinal tuberculosis is more frequently associated with haematogenous pulmonary dissemination, exhibits a stronger inflammatory response and is linked to poorer nutritional status. Meningeal spinal tuberculosis often co-occurs with tuberculous meningitis, with common symptoms including sensory and motor deficits and lumbar back pain. Further, MRI findings indicate that parenchymal tuberculosis predominantly features nodular lesions, whereas meningeal tuberculosis is characterised by dural linear or leptomeningeal enhancement.

Significant differences exist in the clinical and radiological manifestations of parenchymal and meningeal spinal tuberculosis, and MRI enhancement scans play a crucial role in diagnosis, aiding in the optimisation of diagnostic and treatment strategies.