BACKGROUND: Spinal tuberculosis (TB) is the most common form of skeletal tuberculosis. Paradiscal continuous vertebral involvement at a single level is the most prevalent pattern among all forms of spinal TB. There is a wide range of reported incidences of multiple-level non-contiguous spinal TB in the literature. We would like to discuss on the utility of single whole spine screening T2-weighted (T2W) mid-sagittal magnetic resonance imaging (MRI) film in diagnosing multiple-level spinal TB and therapeutic benefits it can provide.
METHODS: We have done a retrospective review of the collected data of patients in Vardhman Mahavir Medical College and Safdarjung Hospital from August 2017 to October 2021 to find the incidence of multiple-level spinal TB and possible factors attributed to this specific disease pattern. All the patients who had been diagnosed of spinal TB either microbiologically or histopathologically or by a good clinical response to anti-tubercular treatment (ATT) and had a whole spine screening MRI film, were included. Patients of spinal TB who did not have a whole spine screening MRI were excluded from the study. Multiple-level spinal TB was diagnosed when lesions were identified in vertebral levels other than a typical paradiscal lesion, and additional lesions were separated from the primary disease by at least one normal spinal segment.
RESULTS: Among the patients, 242 met the inclusion criteria, and 76 showed multiple-level non-contiguous spinal TB on MRI, incidence being 31.4%. The rest of the 166 patients showed typical single-segment contiguous lesions. By doing multivariate analysis to determine the independent risk factors for multiple-level spinal TB, extremes of age (<20 years and >50 years) have been found to be a significant factor with p value of 0.0001. Though drug resistance was not found to be a significant risk factor (p value 0.051), the proportion of patients having multiple-level TB was far more in the drug-resistant group (13/76).
CONCLUSIONS: Single sequence whole spine screening MRI film is an effective, economical, and time-saving tool to detect multiple-level spinal TB. Along with its diagnostic accuracy, it also provides therapeutic benefits like access to a more approachable site for biopsy.

Cervical Pott\'s disease, a form of spinal tuberculosis (TB), is a significant concern in low- and middle-income countries (LMICs). Early detection and treatment are critical to preventing complications like vertebral collapse. Clinical and radiological features of cervical Pott\'s disease can resemble other spinal conditions, posing diagnostic challenges. We present a case of a 28-year-old female who initially presented with quadriplegia, cervical instability, and high-grade fever. Through multidisciplinary collaboration and prompt intervention, the patient was diagnosed with cord compression syndrome secondary to a cervical abscess and probable cervical Pott\'s disease. Anti-tuberculosis treatment (ATT) and steroids were initiated, leading to significant improvement in symptoms and disease resolution. In summary, this case underscores the diagnostic challenge of cervical Pott\'s disease and the importance of imaging in TB diagnosis in resource-limited settings. The positive treatment response emphasizes early intervention\'s significance.

Tuberculosis infection, which is caused by the bacterium Mycobacterium tuberculosis (Mtb), most commonly manifests in patients with respiratory systems. However, it can also colonize other tissues including skeletal. In our case, a 77-year-old Caucasian male presented to the emergency department following a rollover motor vehicle collision with chief complaints of neck and lower back pain. After clinical improvement and a preliminary negative workup, the patient was deemed stable for discharge. Four months later, the patient was subsequently admitted for worsening back pain with workup suspicious for T9 and T10 discitis osteomyelitis and abscess formation on computed tomography (CT). During this admission, spinal Mtb was confirmed by acid-fast stain and real-time polymerase chain reaction of a CT-guided disc space aspirate of a left paraspinal cystic collection at approximately T9-T10. Given these findings, the patient was subsequently put on standard four-drug therapy for Mtb. Our case demonstrates the importance of considering Pott\'s disease in the diagnosis of lumbar spinal pain, especially in patients living in areas with high international migration and travel.