“ The eponym for tuberculous spondylitis with vertebral collapse, this is a destructive process more commonly affecting multiple levels of l...
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The eponym for tuberculous spondylitis with vertebral collapse, this is a destructive process more commonly affecting multiple levels of lower thoracic/upper lumbar vertebrae (L1 most common). It occurs in less than 1% of patients with TB. Patterns of spinal TB infection include spondylodiscitis (centred on the disc) and spondylitis (Pott disease), where the disc is spared until later.
PLAIN FILM
• Loss of endplate margins.
• Anterior scalloping of the vertebral bodies by paravertebral (Pott) abscess—if this contains calcification, it is almost pathognomic.
• Wedge vertebral collapse, focal kyphosis and gibbus.
• Ivory vertebra.
MRI
• Most sensitive—infection starts at the anterior corner of the vertebral body and spreads under the anterior longitudinal ligament (disc spared until later).
• Anterior vertebral bodies scalloped (‘gouge defect’).
• Wedge vertebral collapse.
• Subligamentous, rim-enhancing abscess.
Brucella spondylitis : The lumbar spine (especially L4) is the most common site of Brucella spondylitis (70% of cases). It is difficult to distinguish from tuberculous spondylitis, but features in favour of brucellosis include lower lumbar region-only involvement, normal paraspinal soft tissues and absent gibbus.
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