A 35 yr old lady with chronic backache. On X ray she had a D12 collapse. But Interveebral disc space is maintained. All are possible except:
Correct Answer: Tuberculosis
Description: Tuberculosis (Ref Maheshwari Ohopaedics 3/e p172; Essentials of Radiology and Imaging by Prof S. Bhadury 1/e p193-196] Though IV disc space can be preserved in less common types of TB spine, in the most common (approx 98%) paradiscal variety of TB spine, IV disc space is always involved. "A radiographic finding of destruction of the veebra along with diminution of the interveebral disc space is considered pathognomic of tuberculosis."- T.B. Of Ohopedics By Kotwal 2005/e p91 As a rule neoplastic and traumatic/osteoporotic collapse show sparing of the interveebral disc. Common neoplasms in adult causing veebral collapse are metastasis and multiple myeloma, while in children veebral collapse may indicate histiocytosis (veebra plasm). Disc space narrowing is seen in degenerative diseases and infection of the disc space. Types of spinal tuberculosis Paradiscal (most common type; approx 98% - Ref' Ebnezar 3/e p503): In this the contiguous areas of two adjacent veebrae along with the intervening disc are affected. There is an embryological basis for this type of involvement. A veebra develops from sclerotomes which lie on either side of the notochord. Each pair of sclerotome develops into the lower half of the veebra above, upper half of the veebra below and the intervening IV disc; and has a common blood supply. Therefore hematogenous infections involve this `embryological' section as a whole. Central body type: In this type the central body of the veebra is involved which may lead to veebral collapse. IV disc space is normal. Anterior type: Here the disease stas at the anterior pa of the body and spreads up and down under the anterior longitudinal ligament. Posterior type: Here the posterior complex of the veebra i.e. the pedicle, lamina, spinous process or the transverse process is affected.
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