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Imaging of Spinal Tuberculosis

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Imaging of Tuberculosis

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

Abstract

Spinal tuberculosis remains frequent in low- and middle-income countries, with an increased incidence of infections having been recently observed in developed countries. It represents 25–60% of all musculoskeletal tuberculosis. Tuberculous spondylodiscitis (also called Pott disease), isolated tuberculous vertebral osteomyelitis and primitive neural arch tuberculosis are the three main anatomico-radiological patterns. Magnetic resonance imaging is the gold standard imaging technique for the assessment of spinal tuberculosis, allowing an early and precise diagnosis. In the absence of early and adequate treatment, the disease may progress, leading to spinal deformities and/or neurological impairment. The diagnosis is usually straightforward when the patient already has existing extraskeletal tuberculosis. Otherwise, spinal tuberculosis is typically confirmed by bacteriological and/or histopathological tests.

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Abbreviations

AFB:

Acid-fast bacilli

CT:

Computed tomography

MRI:

Magnetic resonance imaging

TB:

Tuberculosis

References

  • Agrawal V, Patgaonkar PR, Nagariya SP (2010) Tuberculosis of spine. J Craniovertebr Junction Spine 1:74–85

    Article  PubMed  PubMed Central  Google Scholar 

  • Aït Khaled N, Enarson D, Billo N (1997) Epidémiologie de la tuberculose et de la résistance aux antituberculeux. Rev Mal Resp 14:5S8–5S18

    Google Scholar 

  • Al-Shahed MS, Sharif HS, Haddad MC et al (1994) Imaging features of musculoskeletal brucellosis. Radiographics 14:333–348

    Article  CAS  PubMed  Google Scholar 

  • Altini C, Lavelli V, Niccoli-Asabella A et al (2020) Comparison of the diagnostic value of MRI and whole body 18F-FDG PET/CT in diagnosis of spondylodiscitis. J Clin Med 9:1581. https://doi.org/10.3390/jcm9051581

    Article  CAS  PubMed Central  Google Scholar 

  • Ansari S, Ashraf AN, Al-Moutaery K (2001) Spinal infection: a review. Neurosurg Q 11:112–123

    Article  Google Scholar 

  • Ansari S, Amanullah MF, Ahmad K, Rauniyar RK (2013) Pott’s spine: diagnostic imaging modalities and technology advancements. N Am J Med Sci 5:404–411

    Article  PubMed  PubMed Central  Google Scholar 

  • Arias F, Mata-Essayag S, Landaeta ME et al (2004) Candida albicans osteomyelitis: case report and literature review. Int J Infect Dis 8:307–314

    Article  PubMed  Google Scholar 

  • Attia M, Harnof S, Knoller N et al (2004) Cervical Pott’s disease presenting as a retropharyngeal abscess. Isr Med Assoc J 6:438–439

    Google Scholar 

  • Ben Taarit C, Turki S, Ben Maïz H (2003) La tuberculose ostéoarticulaire en Tunisie: étude rétrospective de 180 cas. Med Mal Infect 33:210–214

    Article  Google Scholar 

  • Berbari EF, Kanj SS, Kowalski TJ et al (2015) Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis 61:e26–e46

    Article  PubMed  Google Scholar 

  • Bernard L, Perronne C (1997) La tuberculose ostéo-articulaire aujourd’hui. Presse Med 26:308–310

    CAS  PubMed  Google Scholar 

  • Billo NE (1996) Tendances épidémiologiques de la tuberculose. Rev Prat 46:1332–1335

    CAS  PubMed  Google Scholar 

  • Boussel L, Marchand B, Blineau N et al (2002) Imagerie de la tuberculose ostéo-articulaire. J Radiol 83:1025–1034

    CAS  PubMed  Google Scholar 

  • Caulfield AJ, Wengenack NL (2016) Diagnosis of active tuberculosis disease: from microscopy to molecular techniques. J Clin Tuberc Other Mycobact Dis 4:33–43

    Article  PubMed  PubMed Central  Google Scholar 

  • Chebbi Y, Riahi H, Bouaziz MC et al (2019) Mycobacterium bovis spondylodiscitis: report of 4 cases. J Clin Rheumatol 10:1097

    Google Scholar 

  • Chelli Bouaziz M, Ladeb MF, Chakroun M, Chaabane S (2008) Spinal brucellosis: a review. Skeletal Radiol 37:785–790

    Article  PubMed  Google Scholar 

  • Chelli Bouaziz M, Bougamra I, Kaffel D, Hamdi W, Ghannouchi M, Kchir MM (2010) Non-contiguous multilevel spondylitis: an exceptional presentation of spinal brucellosis. Tunis Med 88:280–284

    Google Scholar 

  • Chelli Bouaziz M, Ladeb MF, Chakroun M (2013) Tuberculose rachidienne. In: Laredo JD, Wybier M, Petrover D (eds) Imagerie rhumatologique et orthopédique. Sauramps Medical, Montpellier, pp 523–538

    Google Scholar 

  • Chelli Bouaziz M, Riahi H, Ladeb MF, Chakroun M, Rammeh S (2017) Imagerie de la tuberculose rachidienne. Encycl Med Chir Radiologie et imagerie médicale-musculosquelettique-neurologique-maxillofaciale, 31–670-C-10

    Google Scholar 

  • Colmenero JD, Jimenez-Mejias ME, Reguera JM et al (2004) Tuberculous vertebral osteomyelitis in the new millennium: still a diagnostic and therapeutic challenge. Eur J Clin Microbiol Infect Dis 23:477–483

    Article  CAS  PubMed  Google Scholar 

  • Comacle P, Le Govic Y, Hoche-Delchet C et al (2016) Spondylodiscitis due to Aspergillus terreus in an immunocompetent host: case report and literature review. Mycopathologia 181:575–581

    Article  PubMed  Google Scholar 

  • Cotten A, Flipo RM, Drouot MH et al (1996) La tuberculose vertébrale. Etude des aspects cliniques et radiologiques à partir d’une série de 82 cas. J Radiol 77:419–426

    CAS  PubMed  Google Scholar 

  • Davies PD, Humphries MJ, Byfield SP et al (1984) Bone and joint tuberculosis. A survey of notifications in England and Wales. J Bone Joint Surg Br 66:326–330

    Article  CAS  PubMed  Google Scholar 

  • De Backer AI, Mortelé KJ, Vanhoenacker FM, Parizel PM (2006) Imaging of extraspinal musculoskeletal tuberculosis. Eur J Radiol 57:119–130

    Article  PubMed  Google Scholar 

  • Dinc H, Ahmetoglu A, Baykal S et al (2002) Image-guided percutaneous drainage of tuberculous iliopsoas and spondylodiskitic abscesses: midterm results. Radiology 225:353–358

    Article  PubMed  Google Scholar 

  • Dorcas CY, David JS (1995) Musculoskeletal tuberculosis. Radiol Clin North Am 33:679–689

    Google Scholar 

  • Durieux P (1990) Epidémiologie de la tuberculose. Rev Prat 40:703–705

    CAS  PubMed  Google Scholar 

  • Engin G, Acunas B, Acunas G, Tunaci M (2000) Imaging of extrapulmonary tuberculosis. Radiographics 20:471–488

    Article  CAS  PubMed  Google Scholar 

  • Eschard JP, Leone J, Etienne JC (1993) Tuberculose osseuse et articulaire des membres. Encycl Méd Chir, Appareil locomoteur, 14–185-A-10:15

    Google Scholar 

  • Francis IM, Das DK, Luthra UK et al (1999) Value of radiologically guided fine needle aspiration cytology (FNAC) in the diagnosis of spinal tuberculosis: a study of 29 cases. Cytopathology 10:390–401

    Article  CAS  PubMed  Google Scholar 

  • Garg RK, Somvanshi DS (2011) Spinal tuberculosis: a review. J Spinal Cord Med. 34:440–454

    Article  PubMed  PubMed Central  Google Scholar 

  • Gasbarrini A, Boriani L, Salvadori C et al (2012) Biopsy for suspected spondylodiscitis. Eur Rev Med Pharmacol Sci 16:26–34

    PubMed  Google Scholar 

  • Golden MP, Vikram HR (2005) Extrapulmonary tuberculosis: an overview. Am Fam Physician 72:1761–1768

    Google Scholar 

  • Gupta S, Takhtani D, Gulati M et al (1999) Sonographically guided fine-needle aspiration biopsy of lytic lesions of the spine: technique and indications. J Clin Ultrasound 27:123–129

    Article  CAS  PubMed  Google Scholar 

  • Gupta R, Garg RK, Jain A et al (2015) Spinal cord and spinal nerve root involvement (myeloradiculopathy) in tuberculous meningitis. Medicine (Baltimore) 94(3):e404

    Article  Google Scholar 

  • Halimi C, Bringard N, Boyer N et al (1999) Brucellome hépatique: deux nouveaux cas et revue de la littérature. Gastroenterol Clin Biol 23:513–517

    CAS  PubMed  Google Scholar 

  • Hamza M (1993) Tuberculose articulaire et vertébrale. Rev Rhum (Ed Fr) 60:115–118

    CAS  Google Scholar 

  • Handa U, Garg S, Mohan H, Garg SK (2009) Role of fine-needle aspiration cytology in tuberculosis of bone. Diagn Cytopathol 38:1–4

    Google Scholar 

  • Harisinghani MG, Mcloud TC, Shepard JA et al (2000) Tuberculosis from head to toe. Radiographics 20:449–470

    Article  CAS  PubMed  Google Scholar 

  • Heysell SK, Thomas TA, Sifri CD, Rehm PK, Houpt ER (2013) 18-fluorodeoxyglucose positron emission tomography for tuberculosis diagnosis and management: a case series. BMC Pulm Med 13:14

    Google Scholar 

  • Huchon G (1997) Tuberculose et mycobactérioses non tuberculeuses Encycl Med Chir, Maladies Infectieuses, 8–038-C-10:20

    Google Scholar 

  • Jain AK (2010) Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg Br 92:905–913

    Article  CAS  PubMed  Google Scholar 

  • Jorda M, Rey L, Hanly A, Ganjei-Azar P (2000) Fine-needle aspiration cytology of bone: accuracy and pitfalls of cytodiagnosis. Cancer 90:47–54

    Article  CAS  PubMed  Google Scholar 

  • Kang M, Gupta S, Khandelwal N et al (1999) CT-guided fine-needle aspiration biopsy of spinal lesions. Acta Radiol 40:474–478

    Article  CAS  PubMed  Google Scholar 

  • Kannivelu A, Tong AKT, Loke KSH, Ng DCE (2021) Nuclear medicine imaging of spinal infection. In: Ladeb MF, Peh WCG (eds) Imaging of spinal infection. Springer Nature Switzerland, pp 71–88

    Chapter  Google Scholar 

  • Kumar K (2017) Posterior spinal tuberculosis: a review. Mycobact Dis 7:243. https://doi.org/10.4172/2161-1068.1000243

    Article  CAS  Google Scholar 

  • Lacerda C, Linhas R, Duarte R (2017) Tuberculous spondylitis: a report of different clinical scenarios and literature update. Case Rep Med. https://doi.org/10.1155/2017/4165301

  • Lacut JY, Dupon M, Paty MC (1995) Tuberculoses extra-pulmonaires. Revue et possibilités de diminution des délais d’intervention thérapeutiques. Méd Mal Infect 25:304–320

    Article  Google Scholar 

  • Ladeb MF, Chelli Bouaziz M, Chakroun M, Loussaief C (2013) Atteintes parasitaires de l’appareil locomoteur. Encycl Med Chir Radiologie et imagerie médicale-musculosquelettique-neurologique-maxillofaciale 31–225-A-10

    Google Scholar 

  • Ladeb MF, Chelli Bouaziz M, Riahi H, Chakroun M (2015) Imagerie de la tuberculose articulaire extra-rachidienne. Encycl Med Chir Radiologie et imagerie médicale-musculosquelettique-neurologique-maxillofaciale 31–220-A-10

    Google Scholar 

  • Ladeb MF, Riahi H, Chelli Bouaziz M, Mechri M (2019) Clinical evolution of tuberculous spondylodiscitis in Tunisia. Bull Acad Natl Med 203:328–333

    Google Scholar 

  • Lamer S, Garel C, Holvoet-Vernaut L, Hassan M (1998) Lésion lytique épiphyso-métaphysaire. Presse Med 27:1197–1198

    CAS  PubMed  Google Scholar 

  • Le Roux P, Quinque K, Bonnel AS, Le Luyer B (2005) Les atteintes extrapulmonaires de la tuberculose de l’enfant. Arch Pédiatrie 12:S122–S126

    Article  Google Scholar 

  • Lefere M, Larbi A, Malghem J, Vande Berg B, Dallaudière B (2014) Vertebral sarcoidosis: long-term follow-up with MRI. Skeletal Radiol 43:1185–1190

    Article  CAS  PubMed  Google Scholar 

  • Lolge S, Maheshwari M, Shah J, Patkar D, Chawla A (2003) Isolated solitary vertebral body tuberculosis—study of seven cases. Clin Radiol 58:545–550

    Google Scholar 

  • Madhok R, Sachdeva P (2016) Evaluation of apparent diffusion coefficient values in spinal tuberculosis by MRI. J Clin Diagn Res 10:TC19–TC23

    PubMed  PubMed Central  Google Scholar 

  • Madkour MM, Sharif HS, Abed M, Al-Fayez MA (1988) Osteoarticular brucellosis. AJR Am J Roentgenol 150:1101–1105

    Article  CAS  PubMed  Google Scholar 

  • Mahboubi S, Morris MC (2001) Imaging of spinal infections in children. Radiol Clin North Am 39:215–222

    Article  CAS  PubMed  Google Scholar 

  • Martini M (1988) Tuberculosis of bone and joints. Springer Verlag, Berlin

    Book  Google Scholar 

  • Masood S (2013) Ultrasound guided fine needle aspiration biopsy: the new challenges and opportunities for cytopathologists. Diagn Cytopathol 41:1017–1018

    Article  PubMed  Google Scholar 

  • Merino P, Candel FJ, Gestoso I, Baos E, Picazo J (2012) Microbiological diagnosis of spinal tuberculosis. Int Orthop 36:233–238

    Article  PubMed  PubMed Central  Google Scholar 

  • Mishra SS, Das D, Das S, Mohanta I, Tripathy SR (2015) Spinal cord compression due to primary intramedullary tuberculoma of the spinal cord presenting as paraplegia: a case report and literature review. Surg Neurol Int 6:42

    Article  PubMed  PubMed Central  Google Scholar 

  • Momjian R, George M (2014) Atypical imaging features of tuberculous spondylitis: case report with literature review. J Radiol Case Rep 8:1–14

    PubMed  PubMed Central  Google Scholar 

  • Moon MS (2014) Tuberculosis of spine: current views in diagnosis and management. Asian Spine J 8:97–111

    Article  PubMed  PubMed Central  Google Scholar 

  • Moore SL, Rafii M (2001) Imaging of musculoskeletal and spinal tuberculosis. Radiol Clin North Am 39:329–342

    Article  CAS  PubMed  Google Scholar 

  • Moorthy S, Prabhu NK (2002) Spectrum of MR imaging findings in spinal tuberculosis. AJR Am J Roentgenol 179:979–983

    Article  PubMed  Google Scholar 

  • Morvan G, Martin N, Massare C, Nahum H (1984) La tuberculose du rachis cervical : étude radiologique à propos d’une série multicentrique de 53 cas. Rev Chir Orthop Reparatrice Appar Mot 70:76–80

    PubMed  Google Scholar 

  • Morvan G, Laredo JD, Wibier M (1998) Imagerie ostéo-articulaire, vol 2. Médecine-Sciences-Flammarion, Paris, pp 756–763

    Google Scholar 

  • Moser T, Ehlinger M, Chelli Bouaziz M, Ladeb MF, Durckel J, Dosch JC (2012) Pitfalls in osteoarticular imaging: how to distinguish bone infection from tumour? Diagn Interv Imaging 93:351–359

    Article  CAS  PubMed  Google Scholar 

  • Murray JF (1996) Expressions cliniques actuelles de la tuberculose. Rev Prat 46:1344–1349

    CAS  PubMed  Google Scholar 

  • Naim-Ur-Rahaman, El Bakry A, Jamjoom ZA, Kolawole TM (1999) Atypical forms of spinal tuberculosis: case report and review of the literature. Surg Neurol 51:602–607

    Article  Google Scholar 

  • Narlawar RS, Shah JR, Pimple MK et al (2002) Isolated tuberculosis of posterior elements of spine: magnetic resonance imaging findings in 33 patients. Spine 27:275–281

    Article  PubMed  Google Scholar 

  • Nassar I, Mahi M, Semlali S et al (2002) Tuberculose de l’arc vertebral postérieur. J Neuroradiol 29:204–207

    CAS  PubMed  Google Scholar 

  • Papavero R, Bissuel F, Gruel S et al (1999) Tuberculose vertébrale de l’enfant. Place de l’imagerie dans la démarche diagnostique et thérapeutique. Presse Med 28:1980–1982

    CAS  PubMed  Google Scholar 

  • Pertuiset E, Beaudreuil J, Horusitzky F et al (1997) Aspects épidémiologiques de la tuberculose ostéo-articulaire de l’adulte. Etude rétrospective de 206 cas diagnostiqués en région parisienne de 1980 à 1994. Presse Med 26:311–315

    CAS  PubMed  Google Scholar 

  • Pertuiset E, Beaudreuil J, Liote F et al (1999) Spinal tuberculosis in adults. A study of 103 cases in a developed country, 1980–1994. Medicine 78:309–320

    Article  CAS  PubMed  Google Scholar 

  • Ramachandran S, Clifton IJ, Collyns TA, Watson JP, Pearson SB (2005) The treatment of spinal tuberculosis: a retrospective study. Int J Tuberc Lung Dis 9:541–544

    CAS  PubMed  Google Scholar 

  • Rasouli MR, Mirkoohi M, Vaccaro AR, Yarandi KK, Rahimi-Movaghar V (2012) Spinal tuberculosis: diagnosis and management. Asian Spine J 6:294–308

    Article  PubMed  PubMed Central  Google Scholar 

  • Rauf F, Chaudhry UR, Atif M, ur Rahaman M (2015) Spinal tuberculosis: our experience and a review of imaging methods. Neuroradiol J 28:498–450

    Article  PubMed  PubMed Central  Google Scholar 

  • Resnick D (1995) Osteomyelitis, septic arthritis and soft tissue infection: organisms. In: Resnick D (ed) Diagnosis of bone and joint disorders, vol 4, 3rd edn. Saunders, Philadelphia, PA, pp 2448–2558

    Google Scholar 

  • Ridley N, Shaikh MI, Remedios D, Mitchell R (1998) Radiology of skeletal tuberculosis. Orthopaedics 21:1213–1220

    Article  CAS  Google Scholar 

  • Rivas-Garcia AI, Sarria-Estrada S, Torrents-Odin C, Casas-Gomila L, Franquet E (2013) Imaging findings of Pott’s disease. Eur Spine J 22(Suppl 4):567–578

    Article  PubMed  Google Scholar 

  • Rua-Figueroa I, Gantes MA et al (2002) Vertebral sarcoidosis: clinical and imaging findings. Semin Arthritis Rheum 31:346–352

    Article  PubMed  Google Scholar 

  • Sharif HS, Aideyan OA, Clark DC et al (1989) Brucellar and tuberculous spondylitis: comparative imaging features. Radiology 171:419–425

    Article  CAS  PubMed  Google Scholar 

  • Sharif HS, Morgan JL, Al Shahed MS, Al Thagafi MY (1995) Role of CT and MR imaging in the management of tuberculous spondylitis. Radiol Clin North Am 33:787–804

    CAS  PubMed  Google Scholar 

  • Shikhare SN, Singh DR, Shimpi TR, Peh WCG (2011) Tuberculous osteomyelitis and spondylodiscitis. Semin Musculoskelet Radiol 15:446–458

    Article  PubMed  Google Scholar 

  • Skaf GS, Kanafani ZA, Araj GF, Kanj SS (2010) Non-pyogenic infections of the spine. Int J Antimicrob Agents 36:99–105

    Article  CAS  PubMed  Google Scholar 

  • Smids C, Kouijzer IJ, Vos FJ et al (2017) A comparison of the diagnostic value of MRI and 18F-FDG-PET/CT in suspected spondylodiscitis. Infection 45:41–49

    Article  PubMed  Google Scholar 

  • Stabler A, Reiser MF (2001) Imaging of spinal infection. Radiol Clin North Am 39:115–135

    Article  CAS  PubMed  Google Scholar 

  • Teo HEL, Peh WCG (2004) Skeletal tuberculosis in children. Pediatr Radiol 34:853–860

    Article  PubMed  Google Scholar 

  • Trecarichi EM, Di Meco E, Mazzotta V, Fantoni M (2012) Tuberculous spondylodiscitis: epidemiology, clinical features, treatment, and outcome. Eur Rev Med Pharmacol Sci 16:58–72

    PubMed  Google Scholar 

  • Tuli SM (2002) General principles of osteoarticular tuberculosis. Clin Orthop 398:11–19

    Article  Google Scholar 

  • Turgut M (2001) Multifocal extensive spinal tuberculosis (Pott’s disease) involving cervical, thoracic and lumbar vertebrae. Br J Neurosurg 15:142–146

    Article  CAS  PubMed  Google Scholar 

  • Valencia MP, Deaver PM, Mammarappallil MC (2009) Sarcoidosis of the thoracic and lumbar vertebrae, mimicking metastasis or multifocal osteomyelitis by MRI: case report. Clin Imaging 33:476–481

    Article  Google Scholar 

  • Wallace R, Cohen AS (1976) Tuberculous arthritis: a report of two cases with review of biopsy and synovial fluid findings. Am J Med 61:277–282

    Article  CAS  PubMed  Google Scholar 

  • Williams RL, Fukui MB, Meltzer CC et al (1999) Fungal spinal osteomyelitis in the immunocompromised patient: MR findings in three cases. AJNR Am J Neuroradiol 20:381–385

    Google Scholar 

  • Wrobel CJ, Chappell ET, Taylor W (2001) Clinical presentation, radiological findings, and treatment results of coccidioidomycosis involving the spine: report on 23 cases. J Neurosurg 95(1 Suppl):33–39

    CAS  PubMed  Google Scholar 

  • Yang CM, Hsu CH, Lee CM, Wang FC (2003) Intense uptake of [F-18]- fluoro-2 deoxy-D-glucose in active pulmonary tuberculosis. Ann Nucl Med 17:407–410

    Article  PubMed  Google Scholar 

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Chelli Bouaziz, M., Ladeb, M.F., Achour, W., Chakroun, M. (2022). Imaging of Spinal Tuberculosis. In: Ladeb, M.F., Peh, W.C.G. (eds) Imaging of Tuberculosis. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/978-3-031-07040-2_12

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