Clinicoradiological Evaluation of Thoracic Spinal Tuberculosis: MRI-Based Assessment of Vertebral Destruction, Epidural Extension, and Neurological Involvement in Patients with Pott's Disease

Abstract

Background: Thoracic spinal tuberculosis (Pott's disease) remains one of the most common forms of extrapulmonary tuberculosis and is a major cause of spinal deformity, instability, and neurological deficits, particularly in developing countries. Magnetic resonance imaging (MRI) plays a pivotal role in the early diagnosis, assessment of disease extent, and treatment planning by accurately depicting vertebral destruction, epidural extension, spinal cord compression, and paraspinal soft tissue involvement. Objective: To evaluate the clinicoradiological characteristics of thoracic spinal tuberculosis using MRI, with particular emphasis on vertebral destruction, epidural extension, spinal cord compression, and their association with neurological involvement. Materials and Methods: A prospective observational study was conducted on patients clinically and radiologically diagnosed with thoracic spinal tuberculosis at a tertiary care neurosurgical center. Demographic details, clinical presentation, neurological status, laboratory findings, and MRI features were systematically recorded. MRI parameters included the number of vertebral bodies involved, degree of vertebral collapse, intervertebral disc involvement, epidural abscess, paravertebral collections, spinal canal compromise, kyphotic deformity, and spinal cord signal abnormalities. Neurological impairment was graded using the American Spinal Injury Association (ASIA) Impairment Scale. Clinicoradiological correlations were analyzed using appropriate statistical methods. Results: Most patients presented with persistent back pain, constitutional symptoms, and varying degrees of lower-limb weakness. MRI commonly demonstrated contiguous vertebral body involvement, endplate destruction, reduced disc height, large paravertebral abscesses, and significant epidural extension causing spinal cord compression. Patients with extensive vertebral destruction and marked epidural compression were more likely to exhibit severe neurological deficits (p < 0.05). Intramedullary T2-weighted hyperintensity was significantly associated with poorer neurological status. MRI findings showed excellent correlation with clinical severity and assisted in identifying patients requiring early surgical decompression. Conclusion: MRI is an indispensable imaging modality for the comprehensive evaluation of thoracic spinal tuberculosis. The extent of vertebral destruction, epidural extension, and spinal cord involvement strongly correlates with neurological impairment. Early MRI-based assessment facilitates timely diagnosis, risk stratification, and individualized management, thereby improving neurological recovery and reducing long-term disability in patients with Pott's disease. Keywords: Thoracic spinal tuberculosis, Pott's disease, Magnetic resonance imaging, Vertebral destruction, Epidural extension, Spinal cord compression, Neurological deficit, ASIA Impairment Scale