1) Dr. U. Jagadish presented on the X-ray findings of tuberculosis (TB) of the spine. 2) The most common sites of spinal involvement in TB are the dorsolumbar spine. Common X-ray findings include narrowing of the disc space and loss of disc margins indicating paradiscal involvement. 3) Other findings include paravertebral shadows produced by tuberculous granulation tissue and abscesses, as well as central lesions causing vertebral body collapse and deformity with minimal disc space narrowing.

1. X-RAY FINDINGS OF TB
SPINE
PRESENTER-DR.U.JAGADISH
JUNIOR RESIDENT
MODERATOR : DR ARUN H S
PROFESSOR AND HOD
DEPT OF ORTHOPAEDICS
RLJALAPPA HOSPITAL KOLAR

2. LESSON PLAN
• Name of the lecturer: Dr.U.Jagadish
• Date: 20/7/2021
• Time: 8 mins.
• Subject: Orthopaedics
• Topic: X RAY FINDINGS IN TB SPINE

3. SPECIFIC LEARNING OBJECTIVES
At the end of the class all participants should be able to know
• Various locations of vertebral involvement
• Various presentations & X-ray finding’s in TB spine

4. INTRODUCTION
• TB spine is the most common extrapulmonary form of disease.
Approximately 10% of patients with extrapulmonary tuberculosis have
skeletal involvement. Spinal tuberculosis accounts for 50% cases of
skeletal tuberculosis.

5. ANATOMY AND PATHOGENESIS
• Most common site of involvement – Dorsolumbar spine due to
1. Greater extent of movement – stress zone transition of kyphosis to
lordosis.
2. Degree of weight bearing
3. Larger surface area of spongy cancellous bone
4. Proximity to cisterna chyli and kidney.
• Order of involvement – lumbar-- upper dorsal– cervical—sacral—
Atlantoaxial.
• Children have increased involvement of cervical spine. Skip lesions are
more common in children.

7. • Spinal involvement usually occurs due to haematogenous spread into
the dense vasculature of cancellous bones of vertebral bodies.
• Primary site is either pulmonary or genitourinary.

9. TYPES OF VERTEBRAL INVOLVEMENT

10. TYPE OF LESIONS
• PARADISCAL LESIONS: It is the most commonest type of lesion
and narrowing of the disc is often the earliest findings.
• Narrowing of disc space with loss of definitions of disc margins
should bring suspicion of paradiscal type of TB spine.

12. • PARAVERTEBRAL SHADOWS: Produced by extension of
tuberculous granulation tissue and the collection of abscess in the
paravertebral region.
• These shadows varies from place to place. In cervical region it
presents as a soft tissue shadow between the vertebral bodies and
pharynx and trachea.

14. • CENTRAL TYPE OF LESIONS: The central disease occurs as a
result of spread of organisms through bateson plexus of veins and
posterior vertebral artery.
• Following infections, marked hyperemia and osteoporosis occurs.
• The body, which is thus softened, easily yields under gravity and
muscle action, leading to compression, collapse and bony deformation.
• Dimunition of disc space is minimal and paravertebral shadow is not
marked.
• The body, which is thus softened, easily yields under gravity an

17. • ANTERIOR TYPE: The lesion occurs when infection starts beneath
the anterior longitudinal ligament and periosteum. The peripheral
portions of the vertebral body(in front and the sides) shows erosions in
lateral view or oblique views as shallow excavations.
• These radiologically visible shallow erosions of the anterior surface of
the vertebral bodies are to be differentiated from aneurysmal
phenomenon observed in cases of tense paravertebral abscess of long
standing cases usually of paradiscal type.
• More erosions is also caused due to the aorta in close proximity to
abscess transmitting aortic pulsations.

20. • APPENDICIAL TYPE: Isolated tuberculous infections of pedicles,
laminae, spinous process, transverse process- rare.
• Radiologically, erosive changes and paravertebral shadows with intact
disc space.

27. THANK YOU