Answer of April 2012

Clinical History:

A 47-year-old lady with back pain. X rays of LS spine, CT abdomen and pelvis and MRI spine were performed.

Diagnosis:

TB spine

Discussion:

LS spine X-ray showed loss of bilateral psaos shadows, loss of L5/S1 disc space associated with endplate destruction and anterolisthesis and large amount of presacral soft tissue density. Mild blurring of the inferior endplate of T12 and superior endplate of L1 is also seen. L5/S1 disc space and endplate destruction, large bilateral psoas collections and presacral collection are seen on CT and MRI. There is also erosion of T12 and L1 endplates and vertebral bodies, associated with a smaller paravertebral collection at the level. Spinal canal is obliterated at L5S1 level.


Tuberculous spondylitis occurs in 5% of patients with tuberculosis. In 50% of cases, no lung lesion is seen. Upper lumber and lower thoracic spine are typically involved. There is predilection for anterior vertebral body adjacent to the endplates. Subligamentous spread beneath the anterior longitudinal ligament is demonstrated in our case at T12/L1 level on MRI, there is corresponding anterior scalloping of L1 on X-ray. The large cold abscesses in bilateral psoas and the calcification within the presacral abscess are typical of TB spine infection.