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British Journal of Neurosurgery 1997; 11(1): 32-38
ORIGINAL ARTICLE
]C RF X
eural arch tuberculosis radiological features and their
correlationwith surgical findingsNAIM-UR-RAHMAN, A. JAMJOOM, Z. A.
B. JAMJOOM A. M. AL-TAHANDivisions of Neurosurgery and Neurology
College of Medicine King Saud University Riyadh Saudi Arabia
AbstractRadiologicalfeatures of 17 cases of neural arch
tuberculosis (NAT), treated surgicallyby the authors, are
reviewedandcorrelatedwith the operativeand
histopathologicalfindings.The diagnosticaccuracyof
differentimagingmodalitiesin theevaluation of this rare, atypical
form of spinal tuberculosiswas found to be very low. Thus, the
initial diagnosiswas inerror in 15 out of 17 of our cases.
Recognition of the radiologicaldiagnostic features of NAT is
important, not onlybecause they maymimic primary or metastatic
spinalneoplasms, but also because of the
surgicalimplications.Computedtomography (CT) and magnetic resonance
imaging (MRl) features correlated most closelywith the surgical
findings,whereas plain spinal radiographs and myelogramswere found
to be non-specific and non-diagnostic.Key words: Spinal compression
spinal computed tomography spinal magnetic resonance imaging spinal
radiology spinaltuberculosis
IntroductionTuberculosis of the spine, in its typical form, is
adisease of two adjacent vertebral bodies with thedestruction of
the intervening intervertebral disc,with or without a paravertebral
or a psoas abscess.1,2A tuberculous process affecting the neural
arch only,with complete sparing of the vertebral bodies
andintervertebral discs, is rare, 1 constituting less than6 of all
the cases of spinal tuberculosis. 1 Thisatypical form of spinal
tuberculosis, although previously reported,I,2 has not been
sufficiently describedin the medical literature. To our knowledge,
this isthe first report to include the MRI features of theneural
arch tuberculosis (NAT). Since the advent ofCT and MRI, more
patients with NAT are beingrecognized; but they still pose
diagnostic problemsbecause they can be easily confused, on
imagingstudies, with primary or metastatic spinal tumours.To better
understand the radiological features ofNAT we have tried to
correlate the imaging featureswith the surgical and
histopathological findings.
Patients and methodsSeventeen patients with NAT (defined as a
tuberculous process affecting the neural arch alone withcomplete
sparing of the vertebral bodies and
intervertebral discs) were treated surgically by theauthors
during last 20 years (Table I). All patientswere referred to the
neurosurgical unit with signsand symptoms of spinal cord
compression, rangingfrom paraesthesias, and increasing weakness of
theextremities to paraplegia and loss of sphincter control. None
ofthem showed visible or palpable spinaldeformity or the typical
radiological appearance ofspinal tuberculosis, i.e. destruction of
the intervertebral disc and two adjoining vertebral bodies. All
thel7 patients had spinal radiographs and myelograms,11 had spinal
CT and MRI of spine was carried outin five patients. Radiological
and preoperative diagnosis was a tumour of the vertebral arch in 15
cases.In one patient the correct diagnosis was suspectedbecause of
the presence of tuberculosis elsewhere.All patients had surgical
decompression and biopsyby posterior (laminectomy) approach and
antitubercular chemotherapy as soon as the diagnosis
wasestablished. Complete resolution of neurologicaldeficits was
obtained in all the patients.ResultsDetails of the patients (age,
sex, clinical features),anatomic location of the lesion, imaging
features,as well as operative and histological findings
aresummarized in Table 1.
Correspondence: Professor Naim-Ur-Rahman, Department of Surgery,
College ofMedicine, p Box 2925, Riyadh 11461, Saudi Arabia,Tel.:
(966-1) 467-1946.Received for publication 8th March 1996. Accepted
for publication 30th April 1996.0268-8697/97/010032-07 9.50 The
Neurosurgical Foundation
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TABLE 1. Summary of 17 cases of NA TAge/sex
natomic siteadiographicyelographic Histologicalyearslinical
featuresof lesionindingsindingsT f indings MRI fi nd ingsperative
findingsindings3/MBrachialgia, paraparesis D1: S+L+T+PDB/EDM at
D1D+FR+PPMD +EDM + PPM + SCC + ? PPAD + PPM + PPA + EDMBG + Pus
+AFB2 28/MTetraparesis suboccipital massl : PA+LMBLB/EDM at ClD
+FR+ PPMD + PPM + SCCD + PPM+EDMBG +AFB3 28/Maraparesis,
brachialgia D1: S+L+T+PDB/EDM atD1D + FR + PPM +EDMD BD + EDMBG +
AFB0/Muboccipital mass tetraparesisl : PA+LMBLDM at C1/2D+FR+PPMD
BD + PPM + EDMBG + AFB7/Mimb spasticity Cl: PA+LMDDM at Cl
/2D+FR+PPMD+PPM+ SCCD + PPM +EDMBG + AFB/Fimb spasticity, ataxia
C2: S + LBLDM at C2D ND BD + PPM + EDMBG + AFB0/Fccipital pain
tetraparesisC2:LBLDM at C2D ND BD+PPM+EDMBG +AFB5/Mrachialgia,
paraparesis C7: S + LBLB/EDM at C7D+FR+PPMD +EDM + PPM +
SCCD+PPM+EDMBG + AFB8/Mrachialgia, paraparesis C7: S + LDB/EDM at
C7D ND BD + EDMBG + AFB9/Maraparesis D1: S+L+PDB/EDM atD1D+FR+PPMD
BD + PPM + EDMBG + AFB6/FParaparesis D1: S+L+P+TDB/EDM
atD1D+FR+PPMD +EDM + PPM + SCCD + PPM +EDMBG + AFB0/Maraparesis D2:
L + TBLB/EDM atD2D + F RD BD + EDMBG5/Maraparesis D2: LBLB/EDM at
D2D ND BD + EDMBG + AFB3/Maraparesis D9: PDB/EDM at D9D + FRD BD +
EDMBG3/Faraparesis D10: PDB/EDM atD10D ND BD + EDMBG +
AFB0/Maraparesis L5 ,S l: LBLB/EDM atL5D ND BD + EDMBG +
AFB9/Mncontinence Sl, 2: LBLB/EDM atSID ND BD+PPM+EDMBG
myelographiclock due to extradural mass; NBL: no bony lesion;
ND: not done; P: pedicle; PA: posterior arch of atlas; PPA:
posterior paraspinal abscess; PPM: posterior paraspinal mass; S:
spine;CC: spinal cord compression; T: transverse process; TBG:
tubercular granuloma.
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