Spinal tuberculosis, also known as Pott's disease, is caused by tuberculosis infection of the spine. It most commonly affects the thoracic and lumbar regions of the spine. Diagnosis involves imaging like x-rays, CT scans, and MRI (the gold standard) combined with clinical signs and symptoms. Treatment depends on the severity and extent of spinal destruction, ranging from antibiotic therapy alone for early or localized disease to surgical interventions like debridement and spinal fusion for advanced cases involving abscesses or neurological deficits. Proper diagnosis and treatment are important to achieve resolution of symptoms and prevent long-term complications like kyphosis and paraplegia.
A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cord below the level of the injury.
A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cord below the level of the injury.
General and simple presentation of tuberculosis of spine on incidence, pathology, complications, management. This presentation is suitable for PGs, Ugs.
spinal tuberculosis, potts spine, tb spine, caries spine,
spine infection, kyphosis
Spinal Tuberculosis by Dr. Monsif IqbalMonsif Iqbal
This is the case presentation of a middle aged lady who presented with severe backache for the last one month with topic review after the case presentation
dr. Rajasekaran dr. Rajasekaran dr. Rajasekaran s
Management of Spinal TB
Chemotherapy
Multidrug antitubercular treatment (ATT) is the mainstay of
treatment in both complicated and uncomplicated TB.65-68
Multidrug ATT is essential, as varying categories of bacilli
exist in a lesion. They may exist as intracellular, extracellular,
dormant, or rapidly multiplying forms and each has different
growth and metabolic properties.69 In addition, multidrug ATT
reduces instances of drug resistance.70 The duration of chemotherapy for spinal TB has been long debated, and the WHO
recommends 9 months of treatment where 4 drugs—isoniazid,
nature in underprivileged sections of developing countries,
TB is now an international concern, as it has its footprints
spread all over the world due to the global migration Epidemiology
The incidence of extrapulmonary TB (EPTB) is low at 3%, but
there has been no significant reduction in incidence of EPTB
when compared to pulmonary TB (PTB).7 Skeletal TB (STB)
contributes to around 10% of EPTB, and spinal TB has been the Clinical Presentation of Spinal TB
The clinical picture of spinal TB is extremely variegated.
Spinal TB usually is insidious in onset and the disease progresses at a slow pace.22 The diagnostic period, since onset
of symptoms, may vary from 2 weeks to several years. The
manifestation of spinal TB depends on the severity and duration of the disease, site of the disease, and the presence of
complications such as abscess, sinuses, deformity, and neurological deficit.23 Spinal TB can either be complicated or
uncomplicated. In complicated TB, patients present with deformity, instability, and neurological deficit. Uncomplicated
spinal TB is one in which diagnosis is made prior to development of such complication Pathophysiology of Spinal TB
TB is caused by Mycobacterium tuberculosis complex, which
has around 60 species. Among them only Mycobacterium
tuberculosis (the most common), Mycobacterium bovis, Mycobacterium microti, and Mycobacterium africanum are known to
affect humans.16 It is a slow-growing fastidious, aerobic bacillus. The primary site of infections can be in the lungs, lymph
nodes of the mediastinum, mesentery, gastrointestinal tract,
genitourinary system, or any other viscera. The bacilli tend to
remain dormant for prolonged periods and multiplies every 15
to 20 hours in aerobic conditions whenever favorable. Spinal
infection is always secondary and is caused by hematogenous
dissemination of the bacillus from a primary focus.17,Cold Abscess
Cold abscess lacks inflammatory features and initially forms in
the infective focus. Later, it takes the path of least resistance
along the natural fascial and neurovascular planes as depic
Potts spine is the classical destruction of disc space and the adjacent bodies , destruction of other spinal elements,severe progressive kyphosis subsequently
Also know as spinal tuberculosis
Vertebral osteomyelitis( spondylodiskitis )
usually seen in adults (median age is 50 to 60 years)
Location
50-60% of cases occur in lumbar spine
30-40% in thoracic spine
~10% in cervical spine
2. Introduction
• Known by many names: spinal tuberculosis,
tuberculous spondylitis, Pott disease or Pott’s
disease
• First described in 1782 by Percival Pott, a British
orthopedic surgeon
3. Pott Disease: Epidemiology
• Pott disease is common in the developing countries
• Skeletal tuberculosis Accounts for 10% of all cases
of extrapulmonary TB
• Targets the hips, knees, spine
• Spinal tuberculosis is most common, accounts for
50% all skeletal TB cases
• men & women equally affected
• Targets thoracic & lumbar vertebrae
4. Pott Disease: Pathophysiology
– Tuberculous bacilli infiltrates the spine via Hematogenous spread
through the dense vasculature of cancellous bone of the anterior
vertebral bodies
– Lymphatic spread from para‐aortic lymph nodes possible but rare
– Up to 75% of infected individuals develop a soft tissue infection
Commonly occurs in the psoas muscle
– Left untreated, degeneration and inflammation of the vertebrae
causes Herniation into the cord space , cord compression
– Kyphosis , gibbous (severe kyphosis)
– Paraplegia
5. CLINICAL FEATURES
• Slowly progressive constitutional symptoms are
predominant in the early stages of the disease,
including weakness, malaise, night sweats, fever,
and weight loss, Pain is a late symptom associated
with bone collapse and paralysis.
• Cervical involvement can cause hoarseness because
of recurrent laryngeal nerve paralysis, dysphagia,
and respiratory stridor (known as Millar asthma).
6. Diagnosis
• History
• Physical examination
• Laboratory investigations
• Plain x rays of the spine
• CT of the spine
• MRI of the spine
• Biopsy
• Bone scan
• Ultra sound scan
7. Pott Disease: Lab FINDINGS
• Laboratory studies suggest chronic disease.
Findings include anemia, hypoproteinemia, and
mild elevation of ESR and CRP. Skin testing may
be helpful but is not diagnostic. The test is
contraindicated in patients with prior
tuberculous infection because of the risk of skin
slough from an intense reaction and is not
useful in patients with suspected reactivation of
the disease.
8. Radiographs: General Features
– Features of Pott’s on radiograph includeSigns of
infection with lytic lucencies in anterior portion of
vertebrae
– Disk space narrowing
– Erosions of the endplate
– Sclerosis resulting from chronic infection
– Compression fracture
– Continuous vertebral body collapse
– Kyphosis; gibbous (severe kyphosis)
9.
10.
11. CT: Features
Soft tissue findings Abscess with calcification is
diagnostic of spinal TB; CT is excellent modality
to visualize soft tissue calcifications
Pattern and severity of bony destruction Pattern of
vertebral body destruction, osteolytic, localized
and sclerotic, and subperiosteal
Used to guide needle in percutaneous needle biopsy
of paraspinal abscess
12.
13.
14. MRI: Features
• Highly sensitive and specific for spinal TB
• Provides early detection
• Best to distinguish exact extent of spinal cord
and soft tissue involvement
• Features Edema of vertebrae and disk space
• Signs of spinal compromise i.e. cord
compression
18. Pott Disease: Treatment
• Various imaging modalities are useful in
determining extent of disease.
• Treatment options then depend on the
degree of spinal destruction
19. Conservative Treatment
• Early Disease:
• Treat with a four drug regimen for six to twelve
months
• Common antibiotics are Rifampin, Isoniazid,
Pyrazinamide, Ethambutol
• Most individuals experience full resolution of
symptoms with appropriate anti‐tuberculosis
treatment
20. Surgical Interventions
• Late Disease:Loosely defined by neurologic
deficits, spinal kyphosis >40%, or failure of
medical therapy
• Surgical debridement, abscess drainage,
and/or vertebral fusion and spinal fixation in
addition to antibiotics
21. Treatment
• Depends upon the type of lesion
• Type 1 A
• The lesion is localised to one vertebra & one
disc degeneration ,no collapse,no abscess &
no neurological deficits.
• The treatment is fine needle biopsy & drug
therapy .
22. Treatment continued
• Type 1 B
• Abscess formation ,one or two level disc
degeneration but no collapse & no
neurological deficits.
• The treatment is abscess drainage &
debridement.
23. Treatment continued
• Type 2
• Abscess formation, vertebral
collapse,kyphosis,stable deformity with or
without neurological deficit.
• The treatment is ;
• Anterior debridement & fusion
• Decompression
• Bone grafting
24. Treatment continued
• Type 3
• Severe vertebral collapse,abscess
formation,severe kyphosis & instable
deformity with or without neurological deficit.
• The treatment is;
• Anterior debridement & fusion
• Decompression
• Correction of deformity & internal fixation
26. Summary
• Imaging modalities are plain film, CT and MRI;
MRI is gold standard for imaging spinal
• Diagnosis and treatment of spinal TB in endemic
areas is difficult given resource limitations; rely
on radiographs and clinical signs to facilitate
early diagnosis.
• Conservative versus surgical treatment of Pott
disease depends on degree of spinal destruction,
making early diagnosis essential for a positive
outcome.