Tuberculosis of the spine: imaging features

Spinal tuberculosis, the most common form of skeletal involvement, is increasing in prevalence because of the resurgence of tuberculosis during the past decade in patients with AIDS, the spread of tuberculosis among the homeless, and the expanding immigrant population. Spinal infection is usually the result of hematogenous seeding of the vertebral body, and the diagnosis often remains elusive because of the indolent nature of tuberculous infection. As a result, the radiographic findings and the signs and symptoms are typically far advanced when the diagnosis is finally established. Radiographic manifestations of tuberculous spondylitis include intraosseous and paraspinal abscess formation, subligamentous spread of infection, vertebral body destruction and collapse, and extension into the spinal epidural space. Significant instability and deformity of the spine can result, mandating prompt diagnosis and treatment to prevent permanent neurologic damage. The purpose of this essay is to illustrate the broad spectrum of imaging findings on plain radiographs, bone scans, CT scans, myelograms, and MR images of patients with spinal tuberculosis. The value of MR imaging in determining the extent of disease is demonstrated.