POTTS SPINE.pptx explanation and treatment

Tuberculosis of spine treatment and surgical procedure

1. POTTS SPINE DR. B. SURAJ VERMA M.B.B.S, M.S, FIAS ASST PROF DEPARTMENT OF ORTHOPAEDICS

2. INDEX 1. ANATOMY 2.ETIOLOGY 3.PREDISPOSING FACTORS 4.PATHOGENESIS 5.SITES OF DISEAS 6. TYPES FO VERTEBRAL LESIONS 7.CLINICAL EVALUATION 8.COMPLICATIONS: 8A) COLD ABSCESS 8B) PARAPLEGIA 9. INVESTIGATIONS: 10 TREATMENT :

3. 1.ANATOMY DEVELOPMENT OF VERTEBRA Each vertebra is formed from 2 adjacent vertebra

4. 2.ETIOLOGY

5. 3.PREDISPOSING FACTORS 1. malnutrition 2.poor sanitation 3.livingin crowded areas 4.close contact with tb patient 5.Immunodeficiency status

6. 4.PATHOGENESIS Primary foci Lung Lymph nodes Secondary Active Quescent latent 1.Arteries 2.Batsone plexus of veins Hematogenous spread Tubercular endarteritis Nodule Collapse of vertebra Angular deformity

7. 5.SITES OF DISEASE MOST COMMON: THORACOLUMBAR REGION 1.amount of movement demand. 2.Near to cysterna chyli and thoracic duct 3.Large amount of spongy tissue 4.Role of trauma Lumbar moves Thoracic Fixed Minor hematoma Activates latent tb focus

8. 6. TYPES FO VERTEBRAL LESIONS 1. PARADISCAL 2.CENTRAL 3.ANTERIOR 4.POSTERIOR

9. 1.PARADISCAL Commenest adolescent Spreads via epiphyseal artery Involves adjacent bodies with reduced disc space

10. 2.CENTRAL children Spreads via batsone plexus of veins disc space normal Concentric collapse (vertebra planus )

11. 3.ANTERIOR Common in thoracic region Infection begins beneath ant long ligament Spinal tumour syndrome (resembles intraspinous tumour )

12. 4.posterior Pedicle transverse process,lamina , spinous process Incidence of neurological deficit is high

13. 7.CLINICAL EVALUATION SYMPTOMS 1.BACK PAIN 2. STIFNESS 3. NIGHT CRIES 4. PARAPLEGIA 5. DEFORMITY: GIBBUS 6. PRESSURE SMPT: DYSPNEA, DYSPHAGIA,HOARSENESS OF VOICE 7.CONSTITUTIONAL SYMPTOMS:

14. ATTITUDE CERVICAL:WRY NECK UPPER THORACIC: MILLITARY ALTTITUDE LOWER THORACIC:ALDERMAN LUMBAR: PRONOUNCED LORDOSIS

15. Gait: Cautious And Careful Tenderness Movements: Neurological Deficits Deformity: KYPHOTIC DEFORMITY 1. ANGULATIONS OF SPINE: ONE : KNUCKLE 2-3 : WEDGE COLLAPSE/ANGULAR KYPHOSID/ GIBBUS >3 : LARGE KYPHOSIS 2. SCOLIOSIS: POST 3. LORDOSIS: COMPENSATORY

16. 8.COMPLICATIONS: 1.COLD ABSCESS 2.PARAPLEGIA 3.SINUSES 4.SECONDARY INFECTION 5.AMYLOID 6.FATALITY

17. Cold abscess Contains Tb debri Tb bacilli Caseating material Granulation tissue Bone lamella Bone marrow Commonest complication of potts spine : 20%

18. CERVICAL ABSCESS Via prevertebral fascia Retropharyngeal abscess Posterior mediastinum lateral preverebral facia Posterior border of SCM Posterior triangle of neck Via post root of c1 Back of neck Cervico axillary fascia axilla Medial side of arm

19. THORACIC ABSCESS Mediastinum Extra pleaural space Press the spical cord Pleaural effusion paraplegia

20. LATERAL ARCUATE LIGAMENT Fascia over Quadratus lumborum Retro renal space 1.Ilioepigastric 2.Ilioinguinal 3.subcostal Ant abdominal wall 1 MEDIAL ARCUATE LIGAMENT PSOAS SHEET ILIAC CREST LT 2 3 MEDIAN ARCUATE AORTA INTERNAL EXTERNAL FEMORAL GLUTEAL PUDENDAL

21. LUMBAR ABSCESS 2 fascias Dorsolumbar fascia Psoas fascia Psoas abscess back 2 nerves Femoral N obturator N Ant Thigh Medial Thigh 2 ARTERIES Sup Gluteal Artery Int Pudendal Gluteal Abscess Ischeorectal Abscess Abdominal Muscles Petits Triangle

22. 9. INVESTIGATIONS: BLOOD: 1.HB: ANEMIA 2. TC: LYMPHOCYTOSIS 3.ESR: ELEVATED 4.LYMP:MONOCYTE RATIO:5:1 5. CRP: ELEVATED MONTOUX TEST: BIOPSY: SPUTUM EXAMINATION: ZN STAIN XRAY: CT SCAN: TO STUDY THE DISTRUCTIVE LESIONS MRI:ABSCESS, SKIP LESIONS,EPIDURAL EXTENTION

23. XRAY FINDINGS 1.Osteopinia 2.Reduced Disc Space 3.Lytic Distruction Vertebral End Plate 4.Osteolytic Destruction Of Vertebral Body 5.Collapse: 6. Deformity: 7.Type Of Lesion 8. Soft Tissue Shadows

24. 1.Cervical : Soft Tissue Shadow Between The Vertebral Body And Pharynx

25. 2. thoracic: C7 to T4 C7 to T4

26. 3. BELOW DIAPHRAM

27. 10 TREATMENT : 1. GENERAL MEASURES: 2. ANTI TUBERCULAR DRUGS: 3. BRACES : CERVICAL :C1 TO T3 SOMI BRACE

28. 10 TREATMENT : 3. BRACES : THORACIC (T4 – L2) TAYLOR BRACE JEWEET BRACE ASH BRACE

29. 10 TREATMENT : 3. BRACES : LUMBO SACRAL: L3 TO S

30. THANK U

31. 4. SURGERY: FAILURE TO IMPROVE PRIMARY DRUG RESISTANCE PREVENT DEFORMITY PERSISTANT COLD ABSCESS PARAPLEGIA

32. HONGKONGS PROCEDURE

33. ANTERIOLATERAL DECOMPRESSION

34. POSTERIOR SPINAL ARTHRODESIS