Medical therapy for spinal tb requires a combination of at least 3 antituberculous drugs. This is a orthopedic teaching video from orthopedic medical students on trauma or elective orthopedic surgery and relevant topics. Purpose to evaluate the efficacy of conservative and surgical treatment for lumbosacral tuberculosis. Spinal tuberculosis is more common in children and young. Spinal tb patients typically present with back pain but other constitutional or pulmonary symptoms may be absent, rendering the diagnosis difficult. Tb of the spine typically occurs following haematogenous spread of mycobacterium tuberculosis from a primary infection site and is characterised by gradual destruction of one or more spinal. Spinal tuberculosis is more common in children and young adults. Pott disease, also known as tuberculous spondylitis, is a classic presentation of extrapulmonary tuberculosis tb.
This condition is of great diagnostic importance due to its link to neurologic deficits and painful spinal deformities. Neural deficit means weakness in the limbs and in late cases complete loss of motor power and loss of bladder bowel control. Spinal tuberculosis accounts for almost 50% cases of skeletal tuberculosis. Introduction described first by sir percival pott in 1779. The purpose of this essay is to illustrate the broad spectrum of imaging findings on plain radiographs, bone scans, ct scans, myelograms, and mr images of patients with spinal tuberculosis. Doctor answers on symptoms, diagnosis, treatment, and more. Surgical site infection ssi continues to be one of the most common postoperative complications in most spine surgeries. Patients with relatively preserved cord size, but with edemamyelitis and predominantly fluid compression on mri respond well to nonoperative treatment. The first modern description of spinal deformity and paraplegia resulting from spinal tb was described by percival pott in 1779. Since then condition is also referred to as potts disease or potts spine. Up to 76% canal encroachment is compatible with a normal neurologic state as the spinal cord tolerates gradually developing compression. He noted this as a painful kyphotic deformity of the spine associated with paraplegia.
Pott disease is tuberculosis of the spine, usually due to haematogenous spread from other sites, often the lungs. Missing red flags in back paintuberculosis of the spine. More typical findings of spinal tuberculosis include destruction of two adjacent vertebral bodies and opposing end. Tb spine history back pain is the earliest and most commonsymptom. It is primarily a medical disease and treat ment consists of a multidrug regimen for 912 months. Spinal tb is a very dangerous type of skeletal tb as it can be. Spinal tuberculosis accounts for nearly half of all cases of musculoskeletal tuberculosis. Student anamnesis autoanmnesis taken at 09 04 2016 chief complain.
The most dreaded neurological complications in tb spine occur in active stage of disease by mechanical compression, instability and inflammation changes, while in healed disease, these occur due to intrinsic changes in spinal cord secondary to internal salient in long standing kyphotic deformity. It is caused by a bacterial microorganism, the tubercle bacillus or mycobacterium tuberculosis. Miliary tuberculosis with vertebral involvement potts disease. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Tuberculosis of the spine also known as kochs spine and tuberculous vertebral osteomyelitis is the commonest form of skeletal tuberculosis and accounts for 88% of chronic vertebral infections. The classic destruction of the disk space and the adjacent vertebral bodies, destruction of other spinal elements, severe and progressive kyphosis subsequently became known as potts disease. Tuberculosis tb is a disease caused by germs that are spread from person to person through.
Tb of the joints has a prolonged onset and is rarely. Weakness both lower limb since 3 months weakness felt gradually worsen, at first patient only complain tried easily when he stand for several time, 3 weeks. Although tb can be treated, cured, and can be prevented if persons at risk take certain. If you dont take medicine, the tb germs may wake up and attack your lungs and other parts of your body, this is called tb disease. Most of the patients with spinal tuberculosis in developed countries are immigrants from countries where tuberculosis is endemic. Tuberculosis of spine or tb spine or spinal tb was first described by percivall pott. Tb usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. Journal tb spine free download as powerpoint presentation. The spine is the most common skeletal site affected, followed by the hip and knee. Extrapulmonary tuberculosis tb is uncommon but not rare. Although uncommon, spinal tb still occurs even in both developed and developing countries 2,3. Early diagnosis of spinal tuberculosis sciencedirect.
Spinal tuberculosis stb is a common manifestation of extrapulmonary. Role of local streptomycin in prevention of surgical site. The current consensus is to diagnose and treat spinal tb early, prevent. Inh and rifampin should be administered during the whole course of therapy. The tuberculosis of the spine also called as potts disease is a pathological condition of the spine where a bacterial infection called tuberculosis gets lodged in the spinal vertebrae. The diagnosis tends to be delayed because of a nonspecific initial early manifestations andor low degree of suspicion. Introduction skeletal tuberculosis is common in india vertebral tuberculosis is the commonest form of skeletal tuberculosis 50% dorsal spine most commonly involved mostly seen in first 3 decades. Spinal tuberculosis in children archives of disease in. Patients with tuberculosis tb of spine are more at risk of developing this complication due to a number of reasons. Spinal tuberculosis is a destructive form of tuberculosis. Tuberculosis of the posterior spinal elements is rare but has a high incidence of neurological morbidity and can cause diagnostic confusion. Spinal the billion dollar marriage contract pdf download.
Most of the patients respond to medications though. Pathophysiology and treatment of spinal tuberculosis. Posterior dislocation of the cervical spine is described, and contrasted with the more common type of anterior dislocation. It can also affect the synovial sheath of the tendons tenosynovitis the incidence of skeletal tuberculosis is 1 t 4%. The middle thoracic region and the cervical spine are less frequently involved.
It is associated with significant morbidity and can lead to severe functional impairment. There were 29 males and 24 females with average ages of 37. Paravertebral abscess formation is an early and important feature of pott disease. The infection can spread from two adjacent vertebrae into the adjoining intervertebral disc space. Spinal tuberculosis and cold abscess without known primary. The diagnosis of spinal tb is difficult and it commonly presents at an. Tb is spread when a person with active tb coughs, sings,or speaks and you breathe the air contaminated with tb germs. Dalagang dinapuan ng potts disease o tuberculosis of the spine, nananawagan ng tulong medikal duration.
Treatment of extrapulmonary tb and of tb in special situations 95. Tb spine with paraplegia the incidence of this complication is 1030 % and it is most often associated with tuberculosis of the dorsal spine. Spinal tuberculosis or potts disease is an infection of the vertebral column caused by mycobacterium tuberculosis. Treatment can be adjusted when susceptibility information becomes available. Outcomes and treatment of lumbosacral spinal tuberculosis. Tuberculosis of spine presentation and treatment bone.
Ankit madharia junior resident lata mangeshkar hospital, nagpur 2. Tuberculosis definition tuberculosis tb is a potentially fatal contagious disease that can affect almost any part of the body but is mainly an infection of the lungs. This is due to the nonspecific presentation ofchronic back pain. Mycobacterium tuberculosis mtb has infected an estimated 2 billion persons worldwide and remains a leading cause of global mortality. Thirtyone patients with 33 lesions of spinal tuberculosis c1d4 are reported. The incidence of spinal tuberculosis is increasing in developed nations. Skeletal tb accounts for 1020% of all extrapulmonary tb, with spinal involvement in 5060% of. The following is the supplementary data related to this article. Spinal tuberculosis synonyms, spinal tuberculosis pronunciation, spinal tuberculosis translation, english dictionary definition of spinal tuberculosis. In the uk, tb is commonly encountered in ethnic groups originating from areas of high endemicity,1, in particular south asia 55% and subsaharan africa 30%. The distribution of lesions was c1c2 11, c3c6, c7d4 9. We believe patients with extradural compression by. It is important to note that thoracic pain is a common presentation of spinal tb as it most commonly affects the thoracic spine, followed by the lumbar spine. Skeletal involvement occurs in 1% to 3% of overall patients with tuberculosis tb.
Rajasekaran et al proposed a formula to predict the final kyphotic deformity in adult population affected with spinal tb. Tb spinecurrent aspects on clinical presentation, diagnosis, and management options. You need to take your medicine to help you get better and prevent spreading the tb germs to others. It is estimated that 50% of skeletal tb is of the spine and extraspinal articulating joints. This revealed 306 cases of tb spine out of which 78 cases with an alternate diagnosis that resembled tb spine were. This adds to significant morbidity and economic burden on patients adversely affecting the mental status and quality of life of patients. The result showed that mdr spinal tb remains a public health concern and commonly affects patients 15. Extra pulmonary tb accounts for about 1520% of all cases and nearly % of patients suffering from tb have involvement of the skeletal system. Tuberculosis tb is a common form of osseous tb, accounting for 50%60% of cases. Tuberculosis tb is the most common infectious disease worldwide, and, in 2009, affected four per 100 000 ukborn children under 5 years old in the uk. Cureus tuberculosis of the left wrist joint and spine. Percivall pott first described about the tuberculosis of the spine as a painful kyphotic deformity of the spine related to the. Tb spine needs to be operated if there is a neural deficit which is not responding to medications or is worsening in spite of medications.
Pdf management of tuberculous infection of the spine. Spinal tuberculosis is uncommon in the western world. They may try to culture to see for check for variants. Significant instability and deformity of the spine can result, mandating prompt diagnosis and treatment to prevent permanent neurologic damage. Tb spine history the reported average duration of symptoms atdiagnosis is 4 months but can be considerablylonger, even in most recent series. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Is tb of the spine contagious things you didnt know. Spinal tuberculosis is secondary to pulmonary or abdominal tb but as well may be the first manifestation of tuberculosis. The mechanism of injury is hyperextension, with disruption of the anterior longi.
Spinal tuberculosis definition of spinal tuberculosis by. A total of 37 patients with spinal tb and 272 patients with mdr spinal tb were analysed. The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected it causes a kind of tuberculous arthritis of the intervertebral joints. Tuberculosis of the spine potts disease presenting as. A judicious combination of conservative therapy and operative decompression when needed should. Mri findings in potts spine and correlating clinical progress with. It is primarily a medical disease and treatment consists of a multidrug regimen for 912 months. In 1782, sir percival pott described spinal tb and surgical treatment of paravertebral abscess.