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MRI findings in Pott’s spine and correlating clinical progress with radiological findings

  • Spinal Neuroradiology
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Abstract

Purpose

To document magnetic resonance imaging (MRI) changes in Pott’s spine and to correlate these with clinical findings and outcome.

Methods

Patients with Pott’s spine having more than one set of MRI were included in the study. Patients were grouped according to timing of their second MRI. The MRI findings included changes in bone, disc, spinal cord, and soft tissue. The MRI changes were categorized into improvement, no change, or worsening. “Paradoxical worsening” was defined as radiological worsening in setting of clinical improvement, as described by improvement of Nurick’s grade. Outcome was defined by mRS scale at three, six, and 12 months. The MRI findings and outcome were correlated.

Results

The results are based on 36 patients. The MRI changes included vertebral changes in form of spondylodiscitis in 33 (92%), epidural abscess in 29 (81%), spinal cord changes including edema and granuloma in 17 (47%), paravertebral abscess in 29 (81%), and vertebral body collapse in 12 (33.3%) patients. At three months, clinical improvement occurred in eight out of 12 patients, deterioration in two, and no change in two. Spinal MRI revealed improvement in one patient only; whereas eight had deterioration and three had no change. At six months, all nine patients improved clinically, but MRI showed improvement in only four, while another four showed deterioration and one had no change. In the nine and 12 months group, while all patients clinically improved, MRI showed minimal worsening.

Conclusion

In Pott’s spine, the clinical improvement precedes the radiological improvement.

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Acknowledgments

We thank Mr. Shakti Kumar for secretarial help.

Funding

The study was not supported by any funding agency.

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Authors and Affiliations

  1. Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India

    Usha Kant Misra, Siddharth Warrier & Jayantee Kalita

  2. Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India

    Sunil Kumar

Authors
  1. Usha Kant Misra
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  2. Siddharth Warrier
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  3. Jayantee Kalita
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  4. Sunil Kumar
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Corresponding author

Correspondence to Usha Kant Misra.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standard of the institutional and/or national research committee and with the 1964 Helsinki declaration and its amendments or comparable ethical standards.

This study was ethically approved by the ethics committee of Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, India (IEC Code: 2018-38-DM-EXP).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Highlights

• In Pott’s spine, vertebral changes occur in 33 (92%), soft tissue changes in 29 (81%), and spinal cord changes in 17 (44%).

• By three months, 66.6% showed clinical improvement which was supported by MRI in 8.3% only.

• Clinical improvement precedes that in MRI.

• To monitor drug response MRI to be repeated if there is lack of clinical improvement.

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Misra, U.K., Warrier, S., Kalita, J. et al. MRI findings in Pott’s spine and correlating clinical progress with radiological findings. Neuroradiology 62, 825–832 (2020). https://doi.org/10.1007/s00234-020-02402-2

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  • DOI: https://doi.org/10.1007/s00234-020-02402-2

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