Bone Pathology Database

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2nd image
Detail of lumbar spine
Third image
MR cervical spine
4th image
Mr T11 vertebra
X rays the upper view show a lytic region destroying the pedicle of T11. There is a soft tissue shadow about the vertebra and loss of disc space between T10 and T11. The middle Magnetic resonance image is of the cervical region. It shows a soft tissue mass about C7 and T1 vertebrae. Compression of the cord had occurred at this lesion. The lower MR is of T11 vertebra. Again the soft tissue mass is seen extending from the vertebral body to the paraspinal muscles posteriorly. This mass was boipsied and caseous material was found. A biopsy of a lymph node also proved positive for tuberculosis. She was HIV negative. Antituberculosis medication was administered.
Spinal Tuberculosis is a lytic process (initially) and involves two (or more) adjacent vertebrae there is usually a large soft tissue component as seen in the views here. The ESR is usually above 100 and there is a relative lymphocytosis. This disease is common in South Africa and if the findings are typical biopsy is not always deemed necessary. We biopsied this lady because the total destruction of the pedicle (seen here in the top X ray) suggested a malignant cause.
Treatment is by antituberculous drugs for at least 18 months.
Neurological fallout that does not respond to treatment, or which worsens on treatment, is an indication for surgery. As the anterior elements are usually affected the approach must be from anterior too.

Record 106