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POTT’S SPINE SEMIFINAL.pptx
1. POTT’S SPINE
Presented by-
DR. SHUBHAM NAGDEV
JR1
Moderator-
DR. ADITYA JADHAV
SENIOR RESIDENT
Department of Orthopaedics
R.D.Gardi Medical College, Ujjain
2. INTRODUCTION
Percival Pott first described tuberculosis of the spinal column in 1779,
stating a classical description as destruction of the disc space and the
adjacent vertebral bodies, collapse of spinal element and progressive
kyphotic deformity
• Spinal tuberculosis (TB) or Pott's spine is the commonest
extrapulmonary manifestation of TB.
• It spreads through hematogenous route via the paravertebral plexus
of veins i.e. Batson’s plexus
3. In order of frequency, the extrapulmonary sites
most commonly involved in TB are the :-
• lymph nodes
• pleura
• genitourinary tract
• bones and joints, (50% of it being vertebral TB)
• meninges
• peritoneum
• pericardium
5. PATHOGENESIS
•
Dissemination of M. Tuberculosis bacilli from a primary focus ( such as Lungs)
Spread via the para vertebral venous plexus i.e. Batson’s Plexus
Bacilli gets lodged on either sides of the disc
Paradiscal lesion (m/c)
Destruction of vertebral end plates and vertebral body
6. •
Progressive involvement of the intervertebral disc
Kyphosis
In later stages of the disease, kyphosis affects 2-3 vertebrae, causing severe kyphosis.
• Severe kyphosis
• Pathological fracture
• Vertebral collapse
• Abscess formation
Neurological deficit due to compression
of spinal cord
8. Types of vertebral Tuberculosis
•
Paradiscal
Central
Anterior
posterior
9. Paradiscal lesion -
• Most common type
• Arterial spread
• 1st radiological finding- narrowing of disc spaces
Disc destruction
Anterior wedging of the vertebra
kyphosis
Involvement of intervertebral disc
10. Central lesion
• Spreads via the batson’s venous plexus
involvement of the central part of vertebral body
Concentric collapse
Vertebra plana
11. Anterior Lesion
• More common in thoracic spine
• Subperiosteal spread
Infection starts beneath the anterior
longitudinal ligament and the periosteum
Pus spreads, separating the anterior longitudinal ligament and
periosteum from the anterior surface of vertebral body
Collapse of the vertebral body Narrowing of
disc spaces
12. Posterior/ appendiceal lesions-
• infection of the pedicles, laminae, transverse processes and
spinous processes
• Less common
• Characterisedby - erosive lesions,
-paravertebral shadows
-intact disc space
13. Skipped lesions-
• More than one TB Lesion in vertebral
column with one or more healthy
vertebrae in between the 2 lesion.
• Best detected on CT/MRI
14. CLINICAL FEATURES
• constitutional symptoms
• back pain
• spine stiffness: spasm of para -vertebral muscle
• night cries
• deformity : knuckle( 1 or 2vertebrae) / gibbus (2 or 3
vertebrae)/ kyphus (angular kyphosis more than 3 vertebrae)
• cold abscess may be present
• paraplegia (if neglected in early stages)
ACTIVE STAGE
15. 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
16. Healing is indicated by
⚫Decreased soft tissue shadow
⚫Return of normal density
⚫Bony ankylosis
24. CT SCAN
• Best to see the patterns of bony
destruction
• 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.
25. MRI
• Highly sensitive and specific for spinal
TB
• Detects marrow infiltration in vertebral
bodies
• Changes of discitis
• Changes of extradural abscess
• Spinal cord and soft tissue involvement
Firstly, whats pott’s spine? It is tubercular infection of the vertebral coloumn, that was first described by percival pott.
Tuberculosis is the most common infection that we come across on a daily basis, and it has got various presentations, based on the system involved.
As we all know, it most commonly involves the lungs.
The other extra pulmonary sites that are affected in order of frequency are –
Vertebra plana- flattening of the vertebral body, with preserved intervertebral disc space
Constitutional symptoms- such as malaise , weight loss, loss of appetite, night sweats, evening rise of temperature
Night cries- due to spasm and movement of the msucles involved
At the end of the slide- now, how do we identify the radiological signs of bone healing?
It is characterized by – next slide
Now, lets look at some of the radiological features of pott’s spine, starting with the x ray findings
These are images showing various stages of spinal tb
Anterior lesion - This lesion occurs when the infection starts beneath the anterior longitudinal ligament and the periosteum.
Pus spreads by stripping anterior longitudinal ligament , periosteum from anterior surface of the vertebral body.
Vertebral body collapse due to pressure and ischemia, followed by disc space narrowing.
Lesion is relatively more common in thoracic spine .
Appendicular lesion - Isolated tuberculosis infection of the pedicles and laminae(neural arch),transverse processes and spinous processes
