Abstract

Objective: To evaluate the usefulness of Magnetic Resonance Imaging (MRI) in Caries spine, avoiding invasive procedures for the diagnosis of the spinal tuberculosis. Patients and Methods: This cross-sectional study was conducted at Department of Orthopedic and Spine surgery, Ghurki |Trust Teaching Hospital Lahore, from January 2012 to May 2016. Patients who underwent surgery for cervical, thoracic and lumbar spinal tuberculosis were inducted in the study. Their MRI were reviewed and eight parameters namely T1 hypo intensity, T2 hyper intensity, epiphyseal involvement, disc involvement, pedicle involvement, anterior subligamentous extension, paraspinal extension and no spinous process involvements were noted. Each of the variables were given 1 point when present and zero when absent. Score of ≥ 6 favored a tuberculous pathology whereas ≤4 were suggestive of non-tuberculous etiology. Results: We evaluated 243 patients of histopathologically proven cases of caries spine. Among these, 129 (53.08%) were females and 114 (46.91%) were males. Mean age of patients was 39.04 years ranging from 8 years to 71 years. Dorsal spine was mainly involved in 105 (43.21%) patients followed by lumbar spine in 91(37.45%) and cervical spine in 47 (19%) patients. Number of vertebrae involved were two or more in each case. Data showed that 238 (97.94%) patients had score ≥ 6 which favored a tuberculous spine whereas 5 (2.06%) patients had scores 5 which suggest antituberculous cause. Conclusion: Our study revealed that objectively outlined eight-point MRI criteria of vertebral lesions is expected to diagnose caries spine with confidence in majority of cases. The proposed scoring system will mitigate the dependency on histopathological diagnosis or invasive method, so that early initiation of anti-tuberculous therapy may be possible. Keywords: Caries spine, Magnetic Resonance Imaging, Scoring system

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