Usefulness of MRI in the Diagnosis and Empiric Treatment of Spinal Tuberculosis: Clinico-Radiological Outcome of 35 Consecutive Cases from a Tertiary Care Hospital

Background: In India, spinal tuberculosis (STB) carries a higher morbidity and mortality rate than other infections. Delays in diagnosis and initiation of treatment are the primary sources of morbidity and mortality. MRI is the earliest diagnostic modality for STB, offering high sensitivity and specificity, and can be used for early diagnosis and treatment initiation. Methods: An observational, retrospective, and prospective study was conducted on a cohort of 35 patients from March 2018 to March 2021, who began empiric treatment based on MRI diagnosis according to a set protocol of the neurosurgery department. An 18-month anti-tubercular treatment (ATT) was initiated in the patients, and clinical profiling, along with MRI at specific intervals, was performed, documented, and compared. Results: Seven patients (100%) of Tuli stage II improved to stage I, three patients (60%) in stage III improved to stage II, and five patients (71%) of stage IV improved to stage II at the end of the study. There were 29 (83%) patients who had a good outcome, and six (17%) patients had no change in clinical status. Contrast-enhanced magnetic resonance imaging (CEMRI) showed a 98.5% positive predictive value in diagnosing STB, and we found it to be an excellent tool for diagnosing and following up on STB patients. Conclusion: Early diagnosis of STB on MRI and early initiation of empiric ATT, with close clinico-radiologic follow-up according to a set protocol, can prevent delays in patients receiving definite treatment in countries like India, which face constraints on health resources and high caseloads.