Question:

Atypical tuberculous spondylitis can show one of the following forms, except:
1. Single vertebral body involvement
2. Isolated involvement of the posterior vertebral elements
3. Sclerotic vertebral body lesion
4. Multi-level (skip) vertebral lesions
5. Contiguous vertebral body lesions with preserved intervertebral discs





Answer:

The correct answer for the question "Atypical tuberculous spondylitis can show one of the following forms, except:" is:

3. Sclerotic vertebral body lesion



Explanation
a- One form of atypical spinal TB is a focal central vertebral body lesion. [Central form of atypical spinal tuberculosis (TB) can be as a single or multiple vertebral involvements. Single vertebral TB is exceedingly rare]
b- Isolated involvement of the posterior vertebral elements is characteristic for spinal TB. [Another rare atypical spinal TB pattern is the isolated involvement of the posterior elements of the vertebrae. It is reported that this occurs characteristically in TB and is not found in pyogenic spondylitis]
c- Lytic, not sclerotic, vertebral lesions are seen in spinal TB. [Differentiation of a focal single tuberculous lesion from other causes of focal vertebral destruction, as focal infection, osteoblastoma and eosinophilic granuloma, is usually difficult on the basis of imaging alone]
d- Multi-level vertebral lesions is seen in atypical spinal TB. [Multi-vertebral lesions may be in continuity or may affect different levels in different regions of the spine (skip lesions)]
e- Multi-segmental vertebral body lesions occur without intervening disc lesions. [Increasingly more common atypical spinal TB is in the form of spondylitis without discal involvement, showing multifocal vertebral involvement without associated disc destruction. The infection typically commences at the superior or inferior vertebral end-plates anteriorly then extends by subligamentous extension over multiple vertebral segments]



From the manuscript:
Atypical Imaging Features of Tuberculous Spondylitis: Case Report with Literature Review
Radiology Case. 2014 Nov; 8(11):1-14


This article belongs to the Neuro section.




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From the manuscript

Atypical Imaging Features of Tuberculous Spondylitis: Case Report with Literature Review

Free full text article: Atypical Imaging Features of Tuberculous Spondylitis: Case Report with Literature Review

Abstract
Spinal tuberculosis in its typical form that shows destruction of two adjacent vertebral bodies and opposing end plates, destruction of the intervening intervertebral disc and a paravertebral or psoas abscess, is easily recognized and readily treated. Atypical tuberculous spondylitis without the above mentioned imaging features, although seen infrequently, has been well documented. We present, in this report, a case of atypical tuberculous spondylitis showing involvement of contiguous lower dorsal vertebral bodies and posterior elements with paravertebral and epidural abscess but with preserved intervertebral discs. The patient presented in advanced stage with progressive severe neurological symptoms due to spinal cord compression. Non-enhanced magnetic resonance imaging led to misdiagnosis of the lesion as a neoplastic process. It was followed by contrast enhanced computed tomography of the chest and abdomen that raised the possibility of an infectious process and, post-operatively, histopathological examination of the operative specimen confirmed tuberculosis. This case indicates the difficulty in differentiating atypical spinal tuberculosis from other diseases causing spinal cord compression. The different forms of atypical tuberculous spondylitis reported in the literature are reviewed. The role of the radiologist in tuberculous spondylitis is not only to recognize the imaging characteristics of the disease by best imaging modality, which is contrast enhanced magnetic resonance imaging, but also to be alert to the more atypical presentations to ensure early diagnosis and prompt treatment to prevent complications. However, when neither clinical examination nor magnetic resonance imaging findings are reliable in differentiating spinal infection from one another and from neoplasm, adequate biopsy, either imaging guided or surgical biopsy is essential for early diagnosis.






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