Radiology Spinal Tuberculosis Koch's Case No #2

Spine is a very important part of human Skeletal System.
Yesterday one patient came to our MRI department
With complaints of black ache. So we did MRI spine and we found it to be tubercular infection. So I thought to make an awareness on it, through this blog.
Since spine has a major role in our body as whole skeleton is attached to it.

It gives structural support as well as houses spinal cord and nerves as an extension from brain.
There are several mussels involved anteriorly and posteriorly to the spine to support multiple types of activities.
Major reason to mention this article is awareness on importance and common diseases that it gets, because of our negligence towards its health.
So heare one of the common but overseen condition of spine became title of this article is Tuberculous Spondylitis.
Apart from trauma, exertion, inflammation, and disc sciatica, the most hard to treat is Tuberculous Spondylitis simply Koch's its named after a scientist.
Tuberculous spondylitis, also known as Pott disease, also refers to vertebral body osteomyelitis and intervertebral discitis from tuberculosis (TB). The spine is the most frequent location of musculoskeletal tuberculosis, and commonly related symptoms are back pain and lower limb weakness/paraplegia.
Tuberculous spondylitis is one of the more common infections of spine in countries where TB is prevalent. Unfortunately, the incidence of tuberculous spondylitis, as with other forms of TB, is on the rise, due to new multiple drug resistant strains.
Inflammatory conditions like discitis and/or osteomyelitis comprise approximately 50% of all musculoskeletal tuberculosis, and usually affect the lower thoracic and upper lumbar levels of the spine where stress is high.
Clinical signs and symptoms.
Patients usually present with back pain, lower limb weakness/paraplegia, and kyphotic deformity (spine deviation). Constitutional symptoms like fever and weight loss are also common but not as pronounced as with bacterial discitis/osteomyelitis.
Cold abscess
In late-stage spinal tuberculosis, large paraspinal abscesses can develop without severe pain or frank pus or prominent inflammatory signs and symptoms; thus called "cold abscess".

Choice of investigation: Cross sectional imaging CT & MRI
MRI is always preferred with intravenous gadolinium contrast agent
Cross-sectional imaging is required to assess better the extent of involvement and particularly for the presence of an epidural component and cord compression.
A pre contrast T2 weighted Saggittal image

Above image arrow showing infective pathology.

And a post contrast T1 weighted Saggittal fat suppression image showing same lesion enhancing

and its extension in adjacent structures on above coronal T1 weighted fat suppression image.
Sometimes it may get worse if treatment is not taken properly. In india TB is very common though the government is taking proper measures to control it.
Source of reference: https://radiopaedia.org/articles/tuberculous-spondylitis-2