Tuberculous (TB) Spondylitis

A 41 year old male presents with lower limb weakness following a fall 2 weeks previously where he injured his knee.
The most common extra pulmonary location of TB is the spine.The thoraco-lumbar spine is the most common site of involvement (50%).
Presenting symptoms include fever, night sweats, anorexia and weight loss which are characteristic symptoms of tuberculosis.
Presentation may also be with neurological fall-out.
 
Infection may originate anteriorly in the vertebral body near the cortex, in the center of the body or adjacent to the end plate.
The infection spreads under the anterior longitudinal ligament resulting in either several contiguous levels involved or skip lesions.
The disc is destroyed only late in the disease.
 
Spinal cord injury may occur secondary to direct pressure from the abscess.

IMAGE 1

Plane x-ray frontal view demonstrates collapse of the T8 vertebral body and superior end plate change of T9.
The abnormal paraspinal soft tissue is also well seen on the right more than the left from T6 to T9.

IMAGE 2

Coronal T1 weighted image with contrast demonstrates the destructive process at T8/T9 with the enhancing paraspinal soft tissue component right more than left reflecting the described spread of infection across several levels.

IMAGE 3

Sagittal T1 with contrast shows the collapsed T8 verterbal body with the enhancing soft tissue infective process extending posteriorly impinging on the spinal cord which is stretched over the mass.