<aside>
Tubercular spondylodiscitis, also known as Pott’s spine or spinal tuberculosis, is a chronic granulomatous infection of the spine caused by Mycobacterium tuberculosis.
</aside>
| Feature | Description |
|---|---|
| Causative agent | Mycobacterium tuberculosis (hematogenous or lymphatic spread) |
| Origin | Typically spreads from a pulmonary or genitourinary focus |
| Infection path | Begins in anterior endplate of vertebral body, spreads to disc/adjacent vertebra |
| Caseating necrosis | Leads to bony destruction, collapse, abscess formation |
| Symptom | Notes |
|---|---|
| Chronic back pain | Most common presenting symptom |
| Constitutional symptoms | Low-grade fever, night sweats, weight loss |
| Paraspinal mass or abscess | Cold abscesses may present as fluctuant masses (e.g., psoas abscess) |
| Neurologic signs | Paraplegia, bladder dysfunction, due to cord compression |
| Kyphotic deformity | Gibbus formation in late stages due to vertebral collapse |
Common Sites of Involvement:
| Region | Frequency & Clinical Significance |
|---|---|
| Thoracic spine | Most common (~50%); high risk for kyphotic deformity |
| Lumbar spine | Second most common; associated with psoas abscess |
| Cervical spine | Rare; high risk of instability and neurologic injury |
| Complication | Description |
|---|---|
| Paraplegia | Due to epidural abscess, spinal cord compression |
| Gibbus deformity | Severe angular kyphosis from collapsed vertebrae |
| Psoas abscess | May present as abdominal or groin swelling |
| Sinus tract/fistula | Cold abscess draining externally |
| Chronic pain/disability | Due to deformity or persistent infection |
| Modality | Imaging features |
|---|---|
| XR | • Anterior vertebral body erosion: Often starts subchondrally |
| • Disc space narrowing: From disc involvement | |
| • Vertebral collapse: Wedge or complete collapse | |
| • ‣: Angular kyphosis due to multi-vertebral collapse | |
| • Paraspinal line displacement: Due to abscess (e.g., psoas shadow in lumbar TB) | |
| CT | • Bony detail: Endplate destruction, calcified abscesses |
| • Guided aspiration: For microbiologic confirmation (AFB, GeneXpert, culture) | |
| MR | • T1: Hypointensity of vertebral bodies, disc |
| • T2/STIR: Hyperintensity due to edema, abscess, inflammation | |
| • CEMR: Rim enhancement of abscesses; vertebral/dural enhancement | |
| • Paraspinal abscess: Cold abscess seen as a well-defined fluid collection | |
| • Epidural extension: Cord compression or thecal sac displacement may be visible |
Tuberculous spondylitis (Pott's disease). Sagittal T1-weighted post contrast magnetic resonance images of spine of 4 different patients showing tuberculous spondylitis (white arrow) of (A) thoracic, (B) lumbar, (C) cervical, and (D) atlanto-axial spine in decreasing order of involvement. The involved vertebral bodies show osseous destruction and heterogeneous contrast enhancement. The intervening discs show early sparing. Associated heterogeneous enhancing prevertebral soft tissue and an epidural phlegmon or abscess is present at each level. The epidural phlegmon or abscess causes canal stenosis, and compression of cord, conus, and cauda equina nerve roots at their respective sites. Subligamentous inflammation (arrow head) and skip lesion (black arrow) can also be well appreciated.
Chaudhary V, Bano S, Garga UC. Central Nervous System Tuberculosis: an Imaging perspective. Canadian Association of Radiologists Journal. 2017;68(2):161-170. doi:10.1016/j.carj.2016.10.007
A) Radiograph of the patient with L5-S1 TB spondylodiscitis with narrowing of disc space and endplate erosion, (B) T2W MRI sagittal images showing prevertebral and epidural abscess (C, D) T2W MRI Axial images showing left psoas abscess.
Rajasekaran Shanmuganathan, Ramachandran K, Shetty AP, Kanna RM. Active tuberculosis of spine: Current updates. North American Spine Society Journal (NASSJ). 2023;16:100267-100267. doi:https://doi.org/10.1016/j.xnsj.2023.100267
Involvement patterns:
<aside>