Role of diffusion tensor imaging in neurological prognostication in spinal tuberculosis – A prospective pilot study

•Role of diffusion tensor imaging (DTI) in infections of the spine such as TB spine is highly unexplored.•Fractional anisotropy (FA) values correlate with the neurological status of individuals with TB spine and its use may be explored as an adjunct to objectively assess the cord damage.•Higher FA value was found to be one of the independent predictors for faster neurological recovery after decompression. The current study aims to explore the correlation between the Diffusion Tensor Imaging (DTI) indices and neurological status of individuals with TB spine with neurological deficit (TBSND). Further, factors affecting the rate of post-operative neurological recovery were also analysed with special emphasis on DTI indices. The current study included 51 individuals with TBSND undergoing posterior instrumentation and posterolateral decompression. All individuals underwent DTI scanning at the site of compression and at a normal level proximal to the disease. The relationship of the DTI parameters with the pre-operative motor, sensory and total scores were analysed. All clinical and radiological parameters were further analysed on the basis of their recovery patterns after decompression surgery. The FA values at the compressed segment were significantly lower while the ADC values were significantly higher when compared with the non-compressed levels. Pre-operative motor and total neurological scores were found to be significantly positively correlated to FA values and ADC values. Faster neurological recovery after decompression was associated with high FA values and younger age while incomplete neurological recovery was associated with high ADC values. Higher FA indices along with lower age constitute independent predictors for faster neurological recovery following decompression. FA values correlate with the neurological status of individuals with TBSND and its use may be explored as an adjunct to objectively assess the cord damage and for predicting neurological recovery pattern after decompression in such individuals.