Correlation Between Clinical, Radiological And Operative Findings In Management Of Tuberculous And Pyogenic Spondylitis.

Abstract

Background: spinal infection is a major category of spinal diseases that is difficult to differentiate clinically from degenerative diseases or spinal neoplasm. Evaluation of the vertebral osteomyelitis and tuberculous spondylitis need an accurate and specific imaging modality to guide the invasive procedures for a definitive microbiological diagnosis and to spare patients with other disorders that might mimic these entities as aggressive neoplastic lesions of the spine. Aim of the work: The aim of this study was to determine the accuracy of MRI for discrimination between different types of spinal infections mainly between tuberculous spondylitis and pyogenic spondylitis. Material and methods: We did a retrospective study of MRI images of 30 patients who had confirmed spondylitis either tuberculous or pyogenic in their MRI of the spine. Then we correlate the clinical and operative findings with the preoperative radiology of the patients. Statistical analysis was performed with the Fisher exact test and Monte Carlo test. Results: The incidence of the following MRI findings was significantly higher in patients with tuberculous spondylitis than in those with pyogenic spondylitis a well-defined paraspinal abnormal signal was present in 14 patients 88% in tuberculous spondylitis vs 4 patients 28% in pyogenic spondylitis, a thin and smooth abscess wall was present in 14 patients 88% in TB vs 2 patients 14% in pyogenic spondylitis , presence of paraspinal or intraosseous abscess (15 patients 93% in TB vs 6 patients 42% in pyogenic infection, subligamentous spread or more than two vertebral levels was detected in 12 patients 75% in TB vs 5 patients 35% in pyogenic spondylitis. thick and irregular abscess wall was present in 5 patients 35% in pyogenic spondylitis vs 0% in TB, a horizontal bandlike sparing of the body was present in 4 patients 28% in pyogenic spondylitis vs 0% in TB. Hyperintense signal on T2-weighted images was more commonly observed in tuberculous spondylitis 15 patients 93% in tuberculous vs 8 patients 57% in pyogenic. The accuracy and specificity of preoperative MRI diagnosis correlated to the postoperative pathological findings was 100% of both types of spondylitis Conclusion: MRI is an accurate and sensitive modality in diagnosis of spinal infection. It also has a high specificity in differentiation of tuberculous spondylitis and pyogenic spondylitis.

Key Words: Tuberculous Spondylitis, Pyogenic Osteomyelities, MRI Spine.