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Tomography of the Spine in Tuberculous Disease

Director of the X-ray Department, London Chest Hospital; Consulting Radiologist to the Essex County Hospital, Black Notley

M. C. Wilkinson, M.B.Lond.

Medical Superintendent and Surgeon to the Surgical Tuberculosis Unit, Essex County Hospital, Black Notley

This excerpt was created in the absence of an abstract.

It is well known that tuberculosis of the spine is first noticeable in the radiograph as a diminution of the space between the vertebral bodies, with decalcification of the adjacent portions of the bone. As caries progresses some collapse occurs, and several vertebral bodies may become involved. Whilst ordinary antero-posterior and lateral radiographs are useful in defining the extent and progress of the disease, there are various situations in which the X-ray examination is made more difficult by the intervention of structures that overlap and obscure the part to be X rayed. Such areas are the first and second cervical vertebræ, the cervicodorsal region, and the lumbo-sacral area. Tomography is of special value in overcoming this difficulty.

Apart from the radiography of the special areas just mentioned, tomography may be of use in obtaining better definition of tuberculous foci in the spine, whatever part is affected. Thus, in one of our patients, the site of origin of a tuberculous sinus could be accurately demonstrated and operative approach made possible. Also, in tuberculous paraplegia, it is difficult to assess the integrity of the spinal canal by the ordinary antero-posterior and lateral films without the aid of tomographs.

In the upper cervical region tuberculous disease may erode the odontoid process, and also damage the check ligament, thus producing a partial dislocation.

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