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suggestion on TB of spine

Two months back, my father had severe back pain in lower region followed by gas formation. He used to have this pain after waking up from sleep in the morning. MRI done revealed destruction of D9/D10 verbetral bodies and intervening disc with large epidural collection severely stenosing the spinal cord, compressing the thecal sac and spinal cord. Mild prevertebral and bilateral paravertebral collection is also present. The destroyed vertebral bodies revealed altered marrow signal appearing hypointense on T1 weighted images and hyperintense on STIR sequences. Pedicles of involved vertebrae reveal evidence of marrow endema. Modic type II end plate changes are present at multiple levels. Rest of intervertebral disc spaces are mantained. However dessication of nucleus pulposus is present at all levels appearing hypointense on T2 weighted images. No Significant disc bulge/herniation is seen. Appearance is suggestive of spondylodiskitis likely to be tubercular. On comparison to previous MRI scan the epidural collection has increased. Two months have passed by and I am concerned by the increase in epidural collection. Is it advisable to go for surgery under such conditions? Please suggest.
Asked On : Mon, 7 Dec 2009
Answers:  1 Views:  1374
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  User's Response
According to your description and the MRI report the cause seems to be intense pressure over the D9/D10 vertebral area pressing on the spinal column. The pressure is probably because of the Tubercular Osteomyelitis with intense edema (water accumulation) around the area pressing on the nerve columns and thus cause the back pain. If this is so then it is better to release the pressure through the surgery. Moreover the edema is increasing in size as per your saying, which also points towards a surgical intervention.
Answered: Sat, 12 Dec 2009
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