Tb Spine Edited

8/3/2019 Tb Spine Edited

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TUBERCULOSIS

SPINE

Group F-2

Medicine Ward IV

By: Rehan Ansari


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THE MOST COMMON INFECTIOUS DISEASE

IN THE WORLD

ONE THIRD OF THE WORLDS

POPULATION HAS LATENT INFECTION

ONE BILLION PEOPLE WILL

BECOME NEWLY INFECTEDB/W 2002-2020


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LYMPHADENITIS

GI DISEASE

Illeocaecal disease

PERICARDIAL DISEASE

Pericardial effusion

Constructive pericarditis

CNS DISEASE

Meningeal disease

GENITOURINARY DISEASE

BONE & JOINT DISEASE

TB SPINE


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Also known as:Potts Caries, Davids Disease, Potts Curvature, POTTS

DISEASE, TUBERCULOUS SPONDYLITIS

Constitutes 40-50% of all cases of Musculoskeletal TBand 1-2% of all cases of Tuberculosis

First described by Percivall Pott in 1779

Commonest cause of of cord compression in countrieswhere TB is common.


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WHOS AFFECTED???

TB EXPOSURE (SE

STATUS) Sex

(male-to-female ratio of 1.5-

2:1). Age

Occurs primarily in adults, indeveloped countries.

But involvement in youngadults and olderchildrenpredominates incountries where incidence of

TB is high.


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location

Most commonly involvesthe thoracic andlumbosacral spine.

Lower thoracic vertebrae(40-50%),

lumbar spine (35-45%).

Cervical Spine (10%)


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PATHOPHYSIOLOGYHematagenous spread (80-90%)

osteomyelitis and arthritis.

Tuberculosis may spread from that area to adjacent intervertebral

disks, or may present as skip lesions.

Progressive bone destruction leads to vertebral collapse and kyphosis(due to collapse of anterior spine)

A cold abscess can occur if the infection extends to adjacent

ligaments and soft tissues.

Abscesses in the lumbar region may descend down the sheath of thepsoas to the femoral trigone region and eventually erode into the skin.


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PATTERNS OF VERTEBRAL

INVOLVEMENT


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PARADISKAL LESIONS

(most common)

ANTERIOR LESIONS

CENTRAL LESIONS


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CLINICAL FEATURESNight Swets

Fever (Evening Rise)

Wt. Loss

Anorexia

BACK PAIN

Dull in character.

The pain becomes worse on walking.Pain may be localized or referred.

UNTREATED

NEUROLOGICALSYMPOMS

POTTS PARAPLEGIA


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GIBBUSDeformity may also result in the

form of a lump or kyphosis,

leading to hunchback.

The changes may extend over

several spinal segments and the

infected vertebrae may collapseleading to severe kyphosis called

Gibbus.


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ASPIRATION

From joint space & abscess

Transparency: turbid.

Colour: creamy.

Consistency: cheesy.

Fibrin clot: large. Mucin clot: poor.

WBC: 25000/cc.mm.


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IMAGING


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TREATMENTTHE DILEMMA

Kyphosis Angle & Neurological Deficit

Control or Correct Kyphosis Angle:

Restore Balance of Spine

Restore Normal Neurology

Preventing Pain

Achieving early bone fusion (healing)

Preventing local recurrence

Preventing Bone Loss


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CONSERVATIVE TREATMENT

Medications

ANTI-TUBERCULARTHERAPY

Isoniazid, Rifampicin,Piyrazinamide

ATA6 MONTHS ADULTS,12 MONTHS CHILDREN

BTA6 MONTHS,REGARDLESS OF AGE

NON-OPERATIVE MEASURESPhysical therapy

Orthosis

Bed rest


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Surgery

TWO COMPONENTS

DEBRIDMENT

(Surgical Removal of

Infected Material)

STABILIZATION OFSPINE

(Spinal Reconstruction)Angle of Kyphosis

CONTROVERSIAL


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INDICATIONS for SURGERY

1. Neurological Deficits (due to cordcompression)

2. Spinal Instability

3. No Response to ChemotherapeuticTreatment

4. Non Diagnostic Biopsy

5. Large Para-spinal Abscess

6. Mild Cases


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