Tuberculosis of spine

Dr.A.Mohan krishnaM.S.Ortho., MCh Orth (U.K)

Consultant Orthopaedic surgeon,

2

Hameatogenous spread

Granuloma formationTissue necrosis & inflammatory response

Paraspinal Abscess

Localized Track along tissue planes

Progressive necrosis of vertebral body-Kyphotic deformity

Adjacent vertebral bodies under the longitudinal ligaments

Along the fascial planes Ex: Psoas abscess

Compressive

Early onset Paraplegia ACTIVE With in 2 years

Late onset paraplegia HEALED After 2 years

Tubercular granulation tissue,Sequestra, abscess,Caseous tissue

Stretching of cord,Myelomalacia,Internal gibbus,

Depends on the severity of involvement of long tracts

Cold abscess / sinuses

Constitutional symptoms: fever, wt loss, night cries (Children)

Back pain is earliest & common symptom

Weakness paraplegia

> 50% of bone destruction before seen radiologically

Classic Radiological triad

Primary Vertebral lesion

Disc space narrowing

Paravertebral abscess

Typical tubercular spondylitic features in

long standing paraspinal abscesses

Aneurysmal phenomenon

Fusiform paraspinal soft tissue shadow

Skip lesions 7-10%

CT or USG guided aspiration : HPE / Microbiology / Culture

3(HRZE) / 3(HRZS) + 3(HRZ)+12(HR)Paediatric age group, streptomycin (for 2 months) replaces ethambutol to avoid optic neuropathy4(HRZE) + 14(HR)