A middle aged male who has a history of Pulmonary Koch's 3 years back with treatment completion p/w Weakness in b/l lower limbs (R>L) and Diminished DTR's since a week...His plantars are NE and power is L(3/5) and R(2/5)....his MRI Spine was done...comment on treatment approach and probable diagnosis

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L3/4 end plates destruction Adjacent vertebral bodies show destruction and sclerosis May be a healed paradiscal TB lesion Neurological features are due to canal compromise and root compression To assess the activity of the disease CBC esr Chest xray Needs decompressive laminectomy Root canal release Curettage of vertebral bodies with biopsy Inter body fusion can be done as bone stock and quality looks good Let a neurosurgeon decide ATT if investigative parameters and biopsy point to active disease
Plain xray lumbosacral lateral view showed osteosclerotic lesionL4 with With narrow L4-5 space with adjacent disc L4-5 .Sagittal Lumbosacral MRI showed partial destruction of L4-5 with end plate changes , narrow l4-5 disc space with l4-5 disc with compression of thecal sac .Axial views not available for further discussion.Probable Cauda equina lesion clinically motor only. No mention about sensory.
Is there any sensory change or level, lower dorsal cord show ? high signal intensity. ? Transverse myelopathy. Pott spine may be regarded as incidental finding as pt already received full course of ATD.
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Mri brain with angio screen ing of whole spine CBC ESR calcium uric acid BMD Rx of cause
Please post coronal and axial cuts of MRI, there is likelihood of Koch's L4-5 paradiscal
Koch's spine.L4 5 Prevertebral abscess. Compreesion cord. Operative .
Prolapse disc with erosion of L3L4 with cord compression correlates with presenting symptoms.so far past history of pulmonary tuberculosis is concerned i don't think related but yes cannot be ignored and should be workout.
Tuberculosis of spine with paraparesis. Middle path regime. First,att with 5..6 drug regime for 6.8 weeks. Review.. If response, then continue. If no response, surgery.. Decompression by antero lateral approach.and fusion
Koch's spine Extra information needed to make clear diagnosis
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