This document discusses tuberculosis of the spine (Pott's disease). It is a tertiary lesion caused by bloodborne tuberculosis infection settling in the vertebral body, causing inflammation and granuloma formation. This can lead to caseous necrosis, abscess formation, and bone and disc destruction. Clinical features include back pain, stiffness, deformity, and potentially paraplegia. Diagnosis involves radiological exams showing vertebral body destruction and abscesses. Treatment involves anti-tubercular therapy along with spinal immobilization and surgery if needed to decompress the spinal cord in cases of paraplegia.
2. TUBERCULOSIS OF SPINETUBERCULOSIS OF SPINE
A TERTIARY LESION OF TB INFECTIONA TERTIARY LESION OF TB INFECTION
MOST COMMON TYPE OF SKELETAL TBMOST COMMON TYPE OF SKELETAL TB
BLOOD BORNE INFECTION SETTLES INBLOOD BORNE INFECTION SETTLES IN
AVERTEBRAL BODYAVERTEBRAL BODY
C/C INFLAMMATORY REACTIONC/C INFLAMMATORY REACTION
MICROSCOPIC LESION – GRANULOMAMICROSCOPIC LESION – GRANULOMA
FORMATIONFORMATION
SMALL PATCHES OF CASEOUSSMALL PATCHES OF CASEOUS
NECROSISNECROSIS
3. CONT……………………….CONT……………………….
COALESCE TO FORM YELLOWISH MASSCOALESCE TO FORM YELLOWISH MASS
CENTER BREAKDOWN, FORM COLDCENTER BREAKDOWN, FORM COLD
ABCESSABCESS
PUSS AND NECROSED BONE FRAGMENTSPUSS AND NECROSED BONE FRAGMENTS
COLD ABSCESS MAY INVOLVE SOFTCOLD ABSCESS MAY INVOLVE SOFT
TISSUE AND SINUS FORMATIONTISSUE AND SINUS FORMATION
COLLAPSE OF IVD, GIBBUS FORMATIONCOLLAPSE OF IVD, GIBBUS FORMATION
6. EXAMINATIONEXAMINATION
GAITGAIT
ATTITUDE AND DEFORMITYATTITUDE AND DEFORMITY
PARA-VERTEBRAL SWELLINGPARA-VERTEBRAL SWELLING
TENDERNESSTENDERNESS
MOVEMENTMOVEMENT
NEUROLOGICAL EXAMINATIONNEUROLOGICAL EXAMINATION
GENERAL EXAMINATIONGENERAL EXAMINATION
7. INVESTIGATIONSINVESTIGATIONS
RADIOLOGICAL EXAMINATIONRADIOLOGICAL EXAMINATION
REDUCTION IN DISC SPACEREDUCTION IN DISC SPACE
DESTRUCTION OF VERTEBRAL BODYDESTRUCTION OF VERTEBRAL BODY
EVIDENCE OF COLD ABSCESSEVIDENCE OF COLD ABSCESS
RAREFACTIONRAREFACTION
SIGNS OF HEALINGSIGNS OF HEALING
10. Central destruction of the
lower half of the vertebral
body, only seen on the
anteroposterior view. The
disc space is slightly
narrowed
11. . The lower disc space is
narrowed .the upper space
is almost normal. A small
lytic defect is present on
the right side of the body
below, and there is a small
Para vertebral abscess.
14. CT scan of a child
showing destruction of
the neural arch on both
sides, as well as of the
vertebral body. Arrows,
anterior spinal abscess.
CT SCAN
16. MYELOGRAPHYMYELOGRAPHY
There is narrowing of theThere is narrowing of the
disc space between the firstdisc space between the first
and second &second andand second &second and
third lumbar vertebraethird lumbar vertebrae
20. NEUROLOGICAL DEFICITNEUROLOGICAL DEFICIT
1.1. SPINAL TUMOURSPINAL TUMOUR
2.2. TRAUMATICTRAUMATIC
3.3. SECONDARIES IN SPINESECONDARIES IN SPINE
21. TREATMENTTREATMENT
AIMAIM
1.1. TO ACHIEVE HEALINGTO ACHIEVE HEALING
2.2. TO PREVENT ,DETECT AND TREATTO PREVENT ,DETECT AND TREAT
EARLY ANY COMPLICATION LIKEEARLY ANY COMPLICATION LIKE
PARAPLEGIAPARAPLEGIA
22. ANTI TUBERCULAR THERAPYANTI TUBERCULAR THERAPY
GENERAL CAREGENERAL CARE
CARE OF SPINECARE OF SPINE
TREATMENTOF COLD ABSCESSTREATMENTOF COLD ABSCESS
24. POTT’S PARAPLEGIAPOTT’S PARAPLEGIA
MOST COMMON IN TB OFMOST COMMON IN TB OF
DORSAL SPINEDORSAL SPINE
--spinal canal is narrowestspinal canal is narrowest
here.here.
INCIDENCE-20%INCIDENCE-20%
25. PATHOLOGYPATHOLOGY
PRESSURE ON NEURAL TISSUES WITHINPRESSURE ON NEURAL TISSUES WITHIN
THE CANAL BY PRODUCTS OF DISEASEDTHE CANAL BY PRODUCTS OF DISEASED
VERTEBRAVERTEBRA
1.1. INFLAMMATORY EDEMAINFLAMMATORY EDEMA
2.2. EXTRADURAL PUS AND GRANULATIONEXTRADURAL PUS AND GRANULATION
TISSUETISSUE
3.3. SEQUESTRASEQUESTRA
4.4. INTERNAL GIBBUSINTERNAL GIBBUS
5.5. INFARCTION OF SPINAL CORDINFARCTION OF SPINAL CORD
6.6. EXTRADURAL GRANULOMAEXTRADURAL GRANULOMA
27. TYPESTYPES
1.1. EARLY ONSET PARAPLEGIA-WithinEARLY ONSET PARAPLEGIA-Within
2 years of onset of disease2 years of onset of disease
2.2. LATE ONSET PARAPLEGIA-At leastLATE ONSET PARAPLEGIA-At least
2 years after onset of disease2 years after onset of disease
29. MECHANICAL CAUSESMECHANICAL CAUSES
1.1. SEQUESTRUM IN THE CANALSEQUESTRUM IN THE CANAL
2.2. INFECTED DEGENERATED DISC IN THEINFECTED DEGENERATED DISC IN THE
CANALCANAL
3.3. PATHOLOGICAL DISLOCATION –A RIDGEPATHOLOGICAL DISLOCATION –A RIDGE
OF BONE PRESSING ON THE CORDOF BONE PRESSING ON THE CORD
30. LATE ONSET PARAPLEGIALATE ONSET PARAPLEGIA
1.1. RECURRENCE OF DISEASERECURRENCE OF DISEASE
2.2. INTERNAL GIBBUSINTERNAL GIBBUS
3.3. FIBROUS SEPTAE FOLLOWING HEALINGFIBROUS SEPTAE FOLLOWING HEALING
31. CLINICAL FEATURESCLINICAL FEATURES
ONSET IS USUALLY GRADUAL BUTONSET IS USUALLY GRADUAL BUT
IN SOME IT IS SUDDENIN SOME IT IS SUDDEN
TUBERCULAR PARAPLEGIA-spastic atTUBERCULAR PARAPLEGIA-spastic at
firstfirst
CLONUS (ankle or patellar)CLONUS (ankle or patellar) ++
32. STAGES OF PARALYSISSTAGES OF PARALYSIS
MUSCLE WEAKNESSMUSCLE WEAKNESS
PARAPLEGIA IN EXTENSIONPARAPLEGIA IN EXTENSION
PARAPLEGIA IN FLEXIONPARAPLEGIA IN FLEXION
COMPLETE FLACCID PARAPLEGIACOMPLETE FLACCID PARAPLEGIA
33. GRADES OF POTTSGRADES OF POTTS
PARAPLEGIAPARAPLEGIA
GRADE I-GRADE I-
PATIENT ISPATIENT IS UNAWARE OF NEURALUNAWARE OF NEURAL
DEFICIT,PHYSICIAN DETECTSDEFICIT,PHYSICIAN DETECTS
BABINSKI +& PATELLAR OR ANKLEBABINSKI +& PATELLAR OR ANKLE
CLONUS ON EXAMINATIONCLONUS ON EXAMINATION
34. GRADE IIGRADE II
PATIENT PRESENTS WITHPATIENT PRESENTS WITH
COMPLAINTS OFCOMPLAINTS OF
CLUMSINESS,INCOORDINATION ORCLUMSINESS,INCOORDINATION OR
SPASTICITY WHILE WALKING BUTSPASTICITY WHILE WALKING BUT
MANAGES TO WALK WITH ORMANAGES TO WALK WITH OR
WITHOUT SUPPORTWITHOUT SUPPORT
35. GRADE IIIGRADE III
PATIENT IS NOT ABLE TO WALKPATIENT IS NOT ABLE TO WALK
BECAUSE OF SEVERE WEAKNESS.ONBECAUSE OF SEVERE WEAKNESS.ON
EXAMINATION HE HAS PARAPLEGIAEXAMINATION HE HAS PARAPLEGIA
ON EXTENSION.THERE MAY BEON EXTENSION.THERE MAY BE
PARTIAL LOSS OF SENSATION.PARTIAL LOSS OF SENSATION.
36. GRADE IVGRADE IV
PATIENT IS UNABLE TO WALKPATIENT IS UNABLE TO WALK
&HAS PARAPLEGIA IN FLEXION&HAS PARAPLEGIA IN FLEXION
WITH SEVERE MUSCLEWITH SEVERE MUSCLE
SPASM.THERE IS NEAR COMPLETESPASM.THERE IS NEAR COMPLETE
LOSS OF SENSATION WITHLOSS OF SENSATION WITH
SPHINCTER DISTURBANCESSPHINCTER DISTURBANCES
40. OPERATIVE TREATMENTOPERATIVE TREATMENT
INDICATIONSINDICATIONS
ABSOLUTEABSOLUTE
1.1. PARAPLEGIA OCCURING DURING USUALPARAPLEGIA OCCURING DURING USUAL
CONSERVATIVE TREATMENTCONSERVATIVE TREATMENT
2.2. NOT RESPONDING TO TREATMENTNOT RESPONDING TO TREATMENT
3.3. RAPID ONSETRAPID ONSET
4.4. UNCONTROLLED SPASTICITYUNCONTROLLED SPASTICITY
5.5. SEVERE PARAPLEGIA WITHSEVERE PARAPLEGIA WITH
MOTOR OR SENSORY LOSS FOR >6MOTOR OR SENSORY LOSS FOR >6
MONTHSMONTHS
TOTAL MOTOR LOSS>1 MONTHTOTAL MOTOR LOSS>1 MONTH
41. RELATIVERELATIVE
1.1. RECURRENT PARAPLEGIARECURRENT PARAPLEGIA
2.2. ONSET IN OLD AGEONSET IN OLD AGE
3.3. PAINFUL PARAPLEGIAPAINFUL PARAPLEGIA
4.4. COMPLICATIONS SUCH AS UTI ANDCOMPLICATIONS SUCH AS UTI AND
STONESSTONES
42. OPERATIVE PROCEDURESOPERATIVE PROCEDURES
AIMAIM
TO REMOVE AGENTS CAUSING COMPRESSION ONTO REMOVE AGENTS CAUSING COMPRESSION ON
NEURAL STRUCTURESNEURAL STRUCTURES
1.1. COSTOTRANSVERSECTOMYCOSTOTRANSVERSECTOMY
2.2. ANTERO LATERAL DECOMPRESSIONANTERO LATERAL DECOMPRESSION
3.3. RADICAL DEBRIDEMENT ANDRADICAL DEBRIDEMENT AND
ARTHRODESISARTHRODESIS
4.4. LAMINECTOMYLAMINECTOMY