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Tuberculosis of the spine

Tuberculosis of the spine






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    Tuberculosis of the spine Tuberculosis of the spine Presentation Transcript

    •  Tb of the spine or Pott’s disease is apresentation of extrapulmonarytuberculosis that affects the spine, a kind of tuberculous arthritis of theintervertebral joints. The lower thoracic and upper lumbarvertebrae are the areas of the spine mostoften affected. Scientifically, it is called tuberculousspondylitis
    •  Pott’s disease results from haematogenousspread of tuberculosis from other sites, oftenpulmonary. The infection then spreads from two adjacentvertebrae into the adjoining intervetebral discspace. If only one vertebra is affected, the disc isnormal, but if two are involved, the disc, whichis avascular, cannot receive nutrients andcollapses. The disc tissue dies leading to intervertebralspace narrowing and eventually to vertebralcollapse and spinal damage.
    •  Incidence In the United States, bone and softtissue tuberculosis accounts forapproximately 10% of extrapulmonaryTB cases and between 1% and 2% oftotal cases. Of these cases, Pott’s disease is themost common manifestation ofmusculoskeletal TB, accounting forapproximately 40-50%.
    •  EthnicityData from the United States show thatmusculoskeletal tuberculosis primarilyaffects African Americans, HispanicAmericans, Asian Americans, andforeign-born individuals.
    •  GenderAlthough some studies have found thatPott’s disease does not have sexualpredilection, the disease is morecommon in males. The male to female ratio is reportedly1.5-2:1.
    •  AgeIn the United States and otherdeveloped countries, Pott’s diseaseoccurs primarily in adults. In underdeveloped countries which havehigher rates of Pott’s disease,involvement in young adults and olderchildren predominates.
    •  back pain Fever Tenderness on furrow of the back night sweating anorexia Spinal mass, sometimes associated withnumbness, paraesthesia, or muscleweakness of the legs Restriction of spinal movements
    •  blood tests elevated erythrocyte sedimentation rate>100 mm/h Mantoux test results are positive in 84-95% of patients with Pott disease whoare not infected with HIV.
    •  radiographs of the spine: Radiographic changes associated withPott’s disease present relatively late. Lytic destruction of anterior portion ofvertebral body Increased anterior wedging Collapse of vertebral body Reactive sclerosis on a progressive lyticprocess Enlarged psoas shadow with or withoutcalcification
    •  bone scan CT of the spine bone biopsy MRI
    •  Vertebral collapse resulting in kyphosis Spinal cord compression Nerve root compression sinus formation paraplegia (so called Potts paraplegia) Disc herniation Psoas abscess Cauda equina syndrome
    •  The medical management is mainlyfocused to eliminate the infection andpain suppression antituberculous drugs(rifampicin,isoniazid,pyrazinamide,ethambutol andstreptomycin Analgesics(pethidine,diclofenac)
    •  Surgery may be necessary, especially todrain spinal abscesses or to stabilize thespine Thoracic spinal fusion is done as a lastresort
    •  Muscle strength mx: Walking Program Aerobic Exercise Trunk Strengthening Spinal stabilization excersizes
    •  Pain mx: Hydrotherapy Therapy TENS Interferential therapy
    •  Excersizes focusing on muscles of theback can strenghthen them preventingfurther kyphosis Electrotherapy modalities are usefull inalleviating pain
    •  Since physio mx is mainly focused onpain and muscle strength it can’t : Reverse the bone destruction that takesplace The necrosis that would have occurredto ivds stop the progression of the diseases
    •  Modalities like ift can’t be used directlyon the vertebral column hence its effectsare not maxmal Continued exercesizes might give amuslce cast in the deformed position
    •  Prognosis is variable, some individuals willrecover completely,particularly if theinfection has been cured. Those requiring longterm suppressivetherapy may develop recurrences if drugtherapy is not maintained Although spinal fusion maybe effective inrelieving pain discomfort depending on theseverity of the symptoms, surgery will nothowever treat the underlying disease
    •  In the past prior to discovery of drugs forTb, 20% of patients died and 30% hadrecurrence of their symptoms.
    •  Apley’s orthopaedic textbook, Clevelandclinic journal ofmedicine,www.physiopedia.com,www.pubmed.com.