TUBERCULOSIS SPINE

Group F-2 Medicine Ward IV By: Rehan Ansari

 THE MOST COMMON INFECTIOUS DISEASE IN THE WORLD

ONE THIRD OF THE WORLDS POPULATION HAS LATENT INFECTION

ONE BILLION PEOPLE WILL BECOME NEWLY INFECTED B/W 2002-2020

LYMPHADENITIS
GI DISEASE
Illeocaecal

GENITOURINARY DISEASE
BONE & JOINT DISEASE

disease TB SPINE

PERICARDIAL DISEASE
Pericardial

effusion pericarditis

Constructive

CNS DISEASE
Meningeal

disease

Also known as: Potts Caries, Davids Disease, Potts Curvature, POTTS DISEASE, TUBERCULOUS SPONDYLITIS

Constitutes 40-50% of all cases of Musculoskeletal TB and 1-2% of all cases of Tuberculosis First described by Percivall Pott in 1779

Commonest cause of of cord compression in countries where TB is common.

WHOS AFFECTED???

TB EXPOSURE (SE STATUS) Sex

(male-to-female ratio of 1.52:1). Occurs primarily in adults, in developed countries. But involvement in young adults and older children predominates in countries where incidence of TB is high.

Age

location

Most commonly involves the thoracic and lumbosacral spine.

Lower thoracic vertebrae (40-50%), lumbar spine (35-45%). Cervical Spine (10%)

PATHOPHYSIOLOGY
Hematagenous 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 the psoas to the femoral trigone region and eventually erode into the skin.

PATTERNS OF VERTEBRAL INVOLVEMENT

PARADISKAL LESIONS (most common)

ANTERIOR LESIONS

CENTRAL LESIONS

CLINICAL FEATURES
Night Swets Fever (Evening Rise) Wt. Loss Anorexia
UNTREATED NEUROLOGICAL SYMPOMS POTTS PARAPLEGIA

BACK PAIN
Dull in character. The pain becomes worse on walking.

Pain may be localized or referred.

GIBBUS
Deformity 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 collapse leading to severe kyphosis called Gibbus.

INVESTIGATIONS
Blood
TLC: Leucocytosis. ESR: raised during acute stage.

Tuberculin skin test

Strongly positive. Negative test does not exclude diagnosis.

Histology
Shows granulomatous tubercle.

ASPIRATION
From joint space & abscess Transparency: turbid.

Colour: creamy. Consistency: cheesy. Fibrin clot: large. Mucin clot: poor. WBC: 25000/cc.mm.

IMAGING

TREATMENT
THE 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

CONSERVATIVE TREATMENT

Medications

ANTI-TUBERCULAR THERAPY

Isoniazid, Rifampicin, Piyrazinamide

ATA6 MONTHS ADULTS, 12 MONTHS CHILDREN BTA6 MONTHS, REGARDLESS OF AGE

NON-OPERATIVE MEASURES
Physical therapy Orthosis Bed rest

Surgery
CONTROVERSIAL

TWO COMPONENTS

DEBRIDMENT (Surgical Removal of Infected Material) STABILIZATION OF SPINE (Spinal Reconstruction)

Angle of Kyphosis

INDICATIONS for SURGERY

1.

2. 3.

4.

5.
6.

Neurological Deficits (due to cord compression) Spinal Instability No Response to Chemotherapeutic Treatment Non Diagnostic Biopsy Large Para-spinal Abscess Mild Cases