Tuberculosis spine

Tuberculosis spine by Dr Bipul Borthakur

1. TUBERCULOSIS OF SPINE
(POTT’S DISEASE)

2. INTRODUCTION
Thespineisthecommonest
siteofbone&jointtuberculosis.
Thechildren&youngadults
mostcommonlyaffected.

3. Themostcommonlyaffected
regionisthedorso-lumberarea.
Itcaninvolvemorethanone
regionofspine.
The vaccinated &
nonvaccinatedbothgroupscan
havespinaltuberculosis.

4. TYPES OF VERTEBRAL
TUBERCULOSIS
1)Paradiscal–commonesttype
2)Central–Bodyofasingle
vertebraisaffected.
3)Anterior–Infectionis
localisedtotheanteriorpartof
vertebralbody.

5. 4)Posterior (appendicial) –
Posterior complex of vertebra
i.e. pedicle, lamina, spinous
process are affected.

7. SKIPLESIONS:Sometimesmorethanone
tuberculouslesionmaybepresentinthevertebral
columnwithoneormorehealthyvertebrain
between.

8. PATHOLOGY
T.B.ofspineisalwayssecondary.
Thebacteriareachesthespineby
heamatogenousroutefromthe
lungs,lymphnodesorintestine.
Itspreadsviatheparavertebral
venousplexus(Batson’splexus).

9. PATHOLOGYCONTD.
The granulomatousinflammation
spreads up and down stripping the
anterior or posterior longitudinal
ligaments and the periosteumfrom
the front and sides of vertebral
bodies. This results in loss of
periostealblood supply and
destruction of many contiguous
vertebral bodies.

11. COLD ABSCESS
Thisisacollectionofpusand
tuberculardebriswithbacillifroma
diseasedvertebra.Theabscessis
calledcoldbecauseitisnot
associatedwith signs of
inflammation.
Thecoldabscesspenetratesthebone
andligamentsandcantrackalongthe
planeofleastresistance--

12. COLD ABSCESS CONTD.
1) Anteriorly-prevertebral abscess,
Retropharyngeal abscess
2) Posteriorly-along the posterior
divisions of spinal nerves,
paravertebral abscess
3) Along 12th thoracic / Ilioinguinal
nerve –Renal abcess.

13. COLD ABSCESS CONTD.
4) Through upper opening of
psoas sheath-Psoas abscess.
5) Passing behind median
arcuate ligament –
Intraabdominal abscess.

15. CLINICAL FEATURES
1)Constitutionalsymptoms-
Fever,weightlossetc.
2)Painpresentingsymptom,it
aggravatesatnight(nightcry)
3)Stiffness-averyearlysymptom
ofT.B.spine.

16. CLINICAL FEATURES CONTD.
4)Paravertebralswelling –a superficial
cold abscess may appear as paravertebral
swelling. It may burst through the skin
forming a discharging sinus.
5)Deformity:
Knuckle-prominenceofasinglespinous
process.
Gibbus–2-3spinousprocessprominence.
Kyphus->3spinousprocessprominence.

17. CLINICAL FEATURES CONTD.
6)Tuberculous paraplegia
(Pott’sparaplegia)-Early
onsetandlateonset
paraplegia.
7)Rarelyasspinaltumour
syndrome.

18. INVESTIGATION
1)Routinebloodexamination–
raised ESR, Anaemia,
lymphocytosis.
2)X-ray(Tofindprimaryfocus)Chest
X-ray&X-rayKUB

19. 3)X-rayofspine
Earliestsignishazzinessofthe
adjacentvertebralbodies&
reductionofdiscspace.
Paravertebral abscess Retropharyngeal abscess

20. Destructionofthevertebral
bodies.
Evidenceofcoldabscess-
paravertebralbirdnesttype
shadow.
Widenedmediastinum.
Aneurysmalsign–inanteriortype.
4)CTscan-Indicatespreciselythe
extentofdestructionofvertebra.

21. 5)MRI–Itistheinvestigationof
choicetoevaluatetypeandextent
ofcompressionofthecordincase
ofPott’sparaplegia.
6)Myelography–indicatedincase
presentingwithspinaltumour
syndrome.
7)Biopsy–ACTguidedbiopsymay
beneededindoubtfulcases.

22. DIFFERENTIAL DIAGNOSIS
1)Spinal pyogenic osteomyelitis.
2)Typhoid spine
3)Brucella spondylitis
4)Mycotic spondylitis
5)Syphyllitic infection of spine.

23. DIFFERENTIAL DIAGNOSIS CONTD.
6)Tumerous condition like
haemangioma, GCT,
aneurysmal bone cyst.
7)Primary spinal tumour
8)Secondary neoplastic deposits
9)Multiple myeloma
10)Spinal osteochondrosis.

24. TREATMENT
Conservative treatment
(Middle path regime)
Rest in hard bed
Antituberculous drugs

25. TREATMENTCONTD.
Gradual mobilisation-after 3-
9 weeks of starting treatment
with suitable spinal braces.
Drainage of cold abscess when
present inspite of conservative
treatment.

26. TREATMENT OF TUBERCULAR PARAPLEGIA

27. INDICATIONS OF OPERATIVE TREATMENT
1)Paraplegiaappearingduringusual
conservativetreatment.
2)Paraplegiagettingworseor
remainingstationarydespite
adequateconservativetreatment.
3)Rapidonsetprogressiveparaplegia.

28. OPERATIVE PROCEDURES
1)Costo-transversectomy.
2)Anterolateraldecompression
3)Radical debridement and
arthrodesis(Hongkong
operation)
4)Surgery for deformity
correction.

29. THANK YOU