(A) (Reduction of disc space) (175 Maheshwsi 2nd)MRI is the neuroimaging of choice for spinal tuberculosis. MRI is more sensitive than x-ray and more specific than CT in the diagnosis of spinal tuberculosis. MRI allows for the rapid determination of the mechanism for neurologic involvement.MRI readily demonstrates involvement of the vertebral bodies, disk destruction, cold abscess, vertebral collapse, and spinal deformities. In the early stages, however, only disk degeneration with alteration of bone marrow signal intensity of vertebra is seen, which may not be sufficiently diagnostic of spinal tuberculosis Abscess formation and collection and expansion of granulation tissue adjacent to the vertebral body is highly suggestive of spinal tuberculosis. MRI is also useful in detecting intramedullary or extramedullarytuberculoma, spinal cord cavitation, spinal cord edema, and possibly unsuspected noncontiguous lesions of the spine. The subligamentousspread of a paraspinal mass and the involvement of multiple contiguous bones and intramedullary spinal changes can be very well demonstrated by MRI* Reduction of disc spaces is the early sign in the commoner; paradiscal type of tuberculosis* The earliest signs of infection are local osteoporosis of the two adjacent vertebrae and narrowing of the intervertebral disc space sometimes with fuzziness of the end plate (Apley)* Back pain is the commonest presenting symptoms* Stiffness is very early symptom in TB of the spine* Intervertebral disc space is preserved in metastasis (secondaries) in the spine* COIN TEST - A child with lumber spasm prefers bending at the hips and knee rather than at the spine when piciking a coin up from the floor* Paraplegia is the most feared complication of spinal tuberculosis* Paravertebral abscess is a fairly constant finding with thoracic diseaseMost common (MC) site of TuberculosisLungs (primary)MC extra pulmonary site of TuberculosisLymph nodeMC site of osteoarticular (skeletal) TuberculosisSpineMC site of Tubercular spondylitistI2-l1MC sequalae of Tubercular spondylitisBony AnkylosisLeast commonly affected bony site in spinal tuberculosisSpinous process* Fibrous ankylosis is a common outcome of the healed tuberculosis of joints except in the spine, where bony ankylosis follows most frequently* Most common type of spinal tuberculosis is ParadiscalBony AnkylosisFibrous Ankylosis1. No movement what ever is possiblei. A little jog of movement is still present on careful examination2. It is painless2, Painful on moving the joints3. Usually a sequelae of septic arthritis or surgically induced arthrodesis3, Usually a sequelae of tubercular arthritis