Role of Magnetic Resonance Imaging in the Evaluation of Soft Tissue Involvement, Complications, and Outcomes in Spinal Tuberculosis

Background: Spinal tuberculosis (Pott’s spine) remains a significant cause of morbidity, especially in developing regions. Early detection and appropriate management are crucial to prevent irreversible neurological deficits and deformities. Magnetic Resonance Imaging (MRI) has emerged as the preferred modality due to its superior ability to detect soft tissue involvement, abscess formation, and neural compression.Aim: This study aimed to evaluate the role of MRI in detecting spinal tuberculosis with specific objectives: (1) To assess soft tissue involvement, pus collection, and their effects on the theca, spinal cord, and nerve roots; and (2) To evaluate delayed complications and treatment outcomes.Methods: A prospective observational study was conducted on 70 patients clinically suspected of spinal TB. Data were collected using a structured case Performa that included demographic details, clinical history, examination findings, MRI features, treatment modality, and follow-up outcomes. MRI parameters analyzed were abscess size, soft tissue involvement, and cord compression grade. Statistical tests included Chi-square, t-test, and correlation analysis, with significance set at p<0.05.Results: The mean patient age was 46.1 years (range 18–78). Soft tissue involvement was present in 52.8% of cases and was significantly associated with larger abscess size (57.4 mm vs. 32.7 mm; p<0.001) and higher grades of cord compression (p<0.001). A positive correlation was found between abscess size and compression grade (r=0.473, p<0.001). Clinical improvement was noted in 78.6% of patients after treatment. Outcomes were similar across medical and surgical groups (p=0.307). Recovery time did not significantly correlate with abscess size or compression severity.Conclusion: MRI played a critical role in detecting early and advanced spinal TB, particularly in identifying soft tissue involvement and guiding therapeutic decisions. Its ability to assess complications and monitor outcomes reinforced its indispensability in comprehensive management of spinal tuberculosis.