Concluded Case

Tuberculous Spondylitis

New case. 62 yr ,M, presented with pain in the neck while lying down and turning to either side since 6 months,insidious onset and progressive in nature.Denied having any radiation of pain. No motor or sensory symptoms. No loss of weight or appetite Known diabetic on regular med.Took treatment for pulmonaryTB 10 yrs ago ,completely cured. On exam vitals stable. Neck movements painful in all direction .No focal neurological deficits. Routein bloid work up including ESR CRP normal Xray chest us normal.. MRI cervical spine done. Diagnosis and management?

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Concluded answer

Thanks Dr,Riju. MRI : Altered morphology with T2/ STIR hyperintense marrow signals involving C5 ( inferior aspect ) C6 ( whole) and C7 ( superior aspect) of vertebrae with involvenent of anterior and posterior elements C6 & C7) and corresponding intervertebral disc with cortical and end plate disruption,loss of vertebral height and perishing tissue component extending to anterior epidural space and neural foramen ,showing patchy areas of mild diffusion restriction and blooming artifact. * Epidural tissue component indenting the cervical spinal cord with altered intramedillary signals and cord edema suggestive of early myelopathy. Imp : Granulomatous etiology like TB / fungal infections. Dd - Lymphoma,mets ,myeloma. CT guided biopsy done- Report TB spondylitis

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Thanks Dr,Riju. MRI : Altered morphology with T2/ STIR hyperintense marrow signals involving C5 ( inferior aspect ) C6 ( whole) and C7 ( superior aspect) of vertebrae with involvenent of anterior and posterior elements C6 & C7) and corresponding intervertebral disc with cortical and end plate disruption,loss of vertebral height and perishing tissue component extending to anterior epidural space and neural foramen ,showing patchy areas of mild diffusion restriction and blooming artifact. * Epidural tissue component indenting the cervical spinal cord with altered intramedillary signals and cord edema suggestive of early myelopathy. Imp : Granulomatous etiology like TB / fungal infections. Dd - Lymphoma,mets ,myeloma. CT guided biopsy done- Report TB spondylitis

Osseous TB is usually secondary Primary focus being lungs There is paraspinal abscess, look like No collapse, Hence no neurological involvement CT guided biopsy and proceed before collapse and cord compression develop

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