potts disease and its treatment and nursing management .pptx

potts disease

1. POTT’S SPINE Kritika Singh 38

2. Regional distribution CERVICAL 12% CERVICODORSAL 5% DORSAL 42% DORSOLUMBAR 12% LUMBAR 26% LUMBOSACRAL 3%

3. • Malnutrition • Poor Sanitation • Over crowding • Close contact with TB patient • Immuno deficiency state predisposing factors

4. TB of spine is always secondary. Bacteria reach the spine via hematogenous route. Spreads via para-vertebral plexus of veins i.e., BATSON’S PLEXUS PATHOLOGY

5. Paradiscal : This is the commonest type .In this, the contagious areas two adjacent vertebrae along with the intervening disc are affected. Central : Body of single vertebrae affected leading to early collapse of the weakened vertebrae. The nearby disc maybe normal. The collapse may be a ‘ wedging’ or ‘ concertina’ collapse. Anterior : Infection is localised to anterior part of vertebral body. Infection spreads up and down under the anterior longitudinal ligament. Posterior : Posterior complex vertebrae i.e., the pedicle, lamina, spinous process and transverse process is affected.

6. CLINICAL FEATURES ACTIVE STAGE HEALED STAGE

7. ACTIVE STAGE Back pain - commonest presenting complaint -diffuse -“radicular pain” PAIN Presents as pain-in the arm (cervical root), -girdle (dorsal root), -abdomen (dorso-lumbar root), -groin (lumbar root), -sciatic (lumbo-sacral root) STIFFNESS Very early symptom. Protective mechanism of the body. COLD ABSCESS Patient may present with a swelling ‘cold abscess’ or problems secondary to its compression effects on nearby vicera. PARAPLEGIA (IF NEGLECTED IN EARLY STAGES) Fever Weight loss Night sweats DEFORMITY CONSTITUIONAL SYMPTOMS

8. HEALED STAGE No systemic features but deformity persists. Radiological evidence of bone healing Patient may present with cold abscess or due to its compression effects: Retropharyngeal abscess — Dysphagia ,dyspnea, hoarseness of voice Mediastinal abscess—Dysphagia Psoas abscess— Flexion deformity of hip

9. NEUROLOGICAL COMPLICATIONS ETIOLOGY : Inflammatory : Inflammatory edema , tuberculous abscess. Mechanical: Tubercular debris, sequestra, cord constriction due to vertebral canal stenosis, localized pressure. Intrinsic: Infective thrombosis, tuberculous meningomyelitis , syringomyelic changes. It is a most serious complication of spinal TB , incidence is approx 20%. MC in dorsal spine because it is the narrowest region ,abscess remains confined under tension. POTT'S PARAPLEGIA

10. EXAMINATION Aim of examination is : —to pick up findings suggestive of TB —to localise the site of lesion —find skip lesions —to detect any associated complications Physical general examination - to detect active or healed primary lesion. The patient may have some other systemic illness ( diabetes, HTN, jaundice etc) Following is the systematic way in which one should process to examine a case of suspected TB of spine :

11. Gait - Patient walks with short steps in order to avoid jerking the spine. In TB of cervical spine, the patient often supports his head with both hands under the chin and twists his whole body in order to look sideways. Attitude and deformity - Tb of cervical spine patient has a stiff, straight neck. In dorsal spine TB, part of the spine becomes prominent (gibbus or kyphus) Para-vertebral swelling - A superficial cold abscess may present as swelling on — the back, along the chest wall or anteriorly. It is easy to diagnose b/a of its fluctuant nature. Tenderness - Elicited by pressing upon the side of spinous process. Movement - Limited spinal movements.

12. Neurological examination - Thorough neurological examination of the — limbs, per or lower, depending on the site of TB should be performed. In addition to motor, sensory reflexes examination, an assessment should be made of urinary or bowel functions. AIM OF NEUROLOGICAL EXAMINATION IS TO FIND: weather of not there is any neurological compression level of neurological compression severity of neurological compression

13. Plain radiograph CT scan MRI spine Bone scan SPINAL TB DIAGNOSIS RADIOLOGICAL DIAGNOSIS TB bacilli are rarely found in CSF, therefore imaging plays important role in the suggesting the diagnosis.

14. • Tuberculin skin test (purified protein derivative [PPD] demonstrates a positive finding in 84-95% of patients who are non HIV positive. • Erythrocyte sedimentation rate (ESR) may be markedly elevated . •The enzyme-linked immunosorbent assay (ELISA) has a reported sensitivity of 60 to 80 per cent • PCR • A brucella complement fixation test LAB STUDIES

15. PLAIN RADIOGRAH

16. Discovertebral lesions, detected in 93% of patients, Localized fluffy osseous destruction with surrounding osteoporosis is the earliest signs. Concentric collapse and may look like A.V.N. Local lytic lesion may cause problem of diagnosis from neoplasic lesion. Destruction of adjacent vertebrae, Konstram (K) angle appears and shows the progress on follow up. Skipped lesion (10% cases) can be diagnosed on suspicion and in correct size film.

17. • Provides much better bony detail of irregular lytic lesions, sclerosis, disk collapse, and disruption of bone circumference. • It detects early lesions and is more effective for defining the shape and calcification of soft tissue abscesses. • In contrast to pyogenic disease, calcification is common in tuberculous lesions. CT SCAN

18. MRI

19. MYELOGRAPHY Spinal tumor syndrome Multiple vertebral lesion Patients not recovered after decompression Block present : second decompression Block not present : intrinsic damage 1.Ischemic infarction 2.Interstitial gliosis 3.atrophy 4. tuberculous myelitis 5.Myelomalacia

20. Pyogenic infections Typhoid spine Brucella Spondylitis Mycotic Spondylitis Syphilitic Tumorous condition Primary malignant tumor Multiple Myeloma Lymphomas Secondary Histocytosis-X Spinal Osteochondrosis Spondylolisthesis Hydatid disease DIFFERENTIAL DIAGNOSIS

21. COMPLICATIONS Paraplegia Cold abscess Sinuses Secondary infection Amyloid disease

22. CONSERVATIVE TREATMENT

23. DRUGS IN MIDDLE PATH TREATMENT

24. SURGICAL TREATMENT

25. SUMMARY