This study evaluated surgical treatment of spinal tuberculosis in 25 patients over a period of 15 months on average. Microbiological testing confirmed tuberculosis in all cases. Patients underwent anterior, posterior, or combined surgical procedures along with 12 months of antitubercular drug therapy. Neurological function improved in all patients. Bony fusion was achieved within 6 months on average. For dorsolumbar lesions, the average kyphosis angle improved from 36 to 17 degrees. The authors concluded that early surgical intervention along with chemotherapy can effectively treat spinal tuberculosis by stabilizing the spine and preventing kyphosis progression.
This document provides information on tuberculosis of the skeletal system, with a focus on vertebral tuberculosis. It begins with an introduction and history of the topic. It then discusses the epidemiology, pathogenesis, clinical presentation, investigations including imaging findings, laboratory tests, classifications, treatment approaches including drug regimens and surgical indications and techniques. Key points covered include the high prevalence of skeletal TB in India, typical radiological features, classification of neurological deficits, Tuli's middle path treatment regime, and various surgical approaches for abscess drainage and spinal decompression/stabilization.
This document discusses the history and treatment of tuberculosis of the spine. It can be summarized in 3 sentences:
The treatment of tuberculosis of the spine has evolved from purely conservative approaches like immobilization to include chemotherapy and surgical interventions like decompression and fusion. Current guidelines recommend initial treatment with anti-tubercular drugs and surgery only for cases with neurological deficits or failure to improve. Ongoing monitoring is important to detect treatment failure or drug resistance requiring modified treatment plans.
spine surgical approaches along with tb spine complicationsPramod Yspam
This document discusses the surgical management and approaches for spinal tuberculosis. Key points include:
- Surgical management includes debridement of diseased vertebrae, drainage of abscesses, arthrodesis for instability, and decompression for neurological complications.
- Common surgical approaches discussed for different spinal regions include anterior, posterior, anterolateral, costotransversectomy, and laminectomy.
- Indications for surgery include neurological deficits not improving with conservative treatment, mechanical instability, and prevention of severe kyphosis.
Surgical Treatment of Spinal TB outlines the history, diagnosis, staging, complications, and treatment of spinal tuberculosis. Spinal TB results from the spread of Mycobacterium tuberculosis to the spine and can cause bone destruction, deformity, and paraplegia. Diagnosis involves imaging like X-ray, CT, MRI along with histopathological confirmation. Treatment involves antituberculous medication for 9-24 months as well as surgical intervention when needed to decompress the spinal cord and reconstruct the spine to prevent deformity and paralysis. Early diagnosis and treatment leads to better outcomes for patients with this dangerous form of tuberculosis.
This document provides information on tuberculosis of the skeletal system (Potts disease). It discusses the history, epidemiology, pathogenesis, clinical presentation, investigations including imaging findings, microbiological studies, treatment including medical management and surgical options, as well as outcomes of skeletal tuberculosis. Key points include that India accounts for a large portion of global tuberculosis cases, it most commonly involves the thoracic spine, and treatment involves a combination of anti-tubercular medications and surgery in some cases to address complications or deformities.
Tuberculosis of Spine for Medical students, Neurosurgeons, Orthopedic Surgeons and Nursing students. Covers history, presentation, clinical features, pathoanatomy, treatment and surgical options. Data taken from textbook by S M Tuli.
This document discusses tuberculosis of the hip. It begins by providing historical context, noting that Robert Koch discovered Mycobacterium tuberculosis in 1882. It then discusses the pathogenesis and presentation of hip TB. Key points include that hip TB is secondary to a primary focus that spreads hematogenously to the hip. Presenting symptoms often include pain and limping. The document outlines the typical pathology and stages of hip TB from synovitis to advanced arthritis and destruction of the joint. Diagnosis involves clinical, radiological, bacteriological and molecular testing. Management includes antitubercular therapy, rest, traction and sometimes surgical interventions like excision arthroplasty or joint replacement.
Instrumentation in cases of tuberculosis of spine Docdeng
This document discusses the management of tuberculosis of the spine using instrumentation. It begins by providing background on tuberculosis of the spine. It then discusses the rationale for using instrumentation in spinal tuberculosis, including to provide stability and allow healing without increased deformity. The document outlines the authors' experience using instrumentation in 18 patients with spinal tuberculosis of varying locations and neurological involvement. It describes the surgical approaches and instrumentation used. Post-operative imaging and outcomes including functional assessment are presented, showing good recovery in most patients. The conclusion emphasizes the role of instrumentation in minimizing deformity in spinal tuberculosis.
This document provides information on tuberculosis of the skeletal system, with a focus on vertebral tuberculosis. It begins with an introduction and history of the topic. It then discusses the epidemiology, pathogenesis, clinical presentation, investigations including imaging findings, laboratory tests, classifications, treatment approaches including drug regimens and surgical indications and techniques. Key points covered include the high prevalence of skeletal TB in India, typical radiological features, classification of neurological deficits, Tuli's middle path treatment regime, and various surgical approaches for abscess drainage and spinal decompression/stabilization.
This document discusses the history and treatment of tuberculosis of the spine. It can be summarized in 3 sentences:
The treatment of tuberculosis of the spine has evolved from purely conservative approaches like immobilization to include chemotherapy and surgical interventions like decompression and fusion. Current guidelines recommend initial treatment with anti-tubercular drugs and surgery only for cases with neurological deficits or failure to improve. Ongoing monitoring is important to detect treatment failure or drug resistance requiring modified treatment plans.
spine surgical approaches along with tb spine complicationsPramod Yspam
This document discusses the surgical management and approaches for spinal tuberculosis. Key points include:
- Surgical management includes debridement of diseased vertebrae, drainage of abscesses, arthrodesis for instability, and decompression for neurological complications.
- Common surgical approaches discussed for different spinal regions include anterior, posterior, anterolateral, costotransversectomy, and laminectomy.
- Indications for surgery include neurological deficits not improving with conservative treatment, mechanical instability, and prevention of severe kyphosis.
Surgical Treatment of Spinal TB outlines the history, diagnosis, staging, complications, and treatment of spinal tuberculosis. Spinal TB results from the spread of Mycobacterium tuberculosis to the spine and can cause bone destruction, deformity, and paraplegia. Diagnosis involves imaging like X-ray, CT, MRI along with histopathological confirmation. Treatment involves antituberculous medication for 9-24 months as well as surgical intervention when needed to decompress the spinal cord and reconstruct the spine to prevent deformity and paralysis. Early diagnosis and treatment leads to better outcomes for patients with this dangerous form of tuberculosis.
This document provides information on tuberculosis of the skeletal system (Potts disease). It discusses the history, epidemiology, pathogenesis, clinical presentation, investigations including imaging findings, microbiological studies, treatment including medical management and surgical options, as well as outcomes of skeletal tuberculosis. Key points include that India accounts for a large portion of global tuberculosis cases, it most commonly involves the thoracic spine, and treatment involves a combination of anti-tubercular medications and surgery in some cases to address complications or deformities.
Tuberculosis of Spine for Medical students, Neurosurgeons, Orthopedic Surgeons and Nursing students. Covers history, presentation, clinical features, pathoanatomy, treatment and surgical options. Data taken from textbook by S M Tuli.
This document discusses tuberculosis of the hip. It begins by providing historical context, noting that Robert Koch discovered Mycobacterium tuberculosis in 1882. It then discusses the pathogenesis and presentation of hip TB. Key points include that hip TB is secondary to a primary focus that spreads hematogenously to the hip. Presenting symptoms often include pain and limping. The document outlines the typical pathology and stages of hip TB from synovitis to advanced arthritis and destruction of the joint. Diagnosis involves clinical, radiological, bacteriological and molecular testing. Management includes antitubercular therapy, rest, traction and sometimes surgical interventions like excision arthroplasty or joint replacement.
Instrumentation in cases of tuberculosis of spine Docdeng
This document discusses the management of tuberculosis of the spine using instrumentation. It begins by providing background on tuberculosis of the spine. It then discusses the rationale for using instrumentation in spinal tuberculosis, including to provide stability and allow healing without increased deformity. The document outlines the authors' experience using instrumentation in 18 patients with spinal tuberculosis of varying locations and neurological involvement. It describes the surgical approaches and instrumentation used. Post-operative imaging and outcomes including functional assessment are presented, showing good recovery in most patients. The conclusion emphasizes the role of instrumentation in minimizing deformity in spinal tuberculosis.
This document summarizes a post graduate seminar on skeletal tuberculosis. It discusses the etiology, pathogenesis, clinical presentation, investigations and management of skeletal tuberculosis. Mycobacterium tuberculosis commonly affects the lungs but can spread to bones and joints. Skeletal tuberculosis is transmitted through airborne droplets and causes chronic granulomatous lesions. Symptoms include low grade fever, pain and swelling. Investigations include x-rays showing bone destruction, biopsy to identify tubercles, and cultures. Treatment involves antitubercular drugs administered under DOTS guidelines for 6-8 months. Surgery may be needed for complications or neurological involvement. Proper treatment can cure tuberculosis in most cases.
This document discusses tuberculosis of the spine (Pott's disease). It notes that the spine is the most common site of bone involvement by tuberculosis, with the lower thoracic and lumbar vertebrae most often affected. Tuberculosis of the spine typically begins in the cancellous bone and spreads to adjacent vertebrae and discs. This can lead to abscesses that track through soft tissues, potentially causing epidural abscesses and spinal cord compression. Imaging plays an important role in evaluating the extent of bone and soft tissue involvement.
Spinal Tuberculosis by Dr. Monsif IqbalMonsif Iqbal
This document presents a case of spinal tuberculosis. It describes a 45-year-old female patient who presented with severe back pain of one week duration. Examination found tenderness in the lumbar spine and limited straight leg raise. Imaging including x-ray and MRI confirmed the diagnosis of spinal tuberculosis affecting L1 and L2. The document then provides details on the pathogenesis, clinical presentation, diagnosis, imaging features, complications and management of spinal tuberculosis.
Tuberculosis was popularly known as consumption for a long time. Scientists know it as an infection caused by M. tuberculosis. In 1882, the microbiologist Robert Koch discovered the tubercle bacillus, at a time when one of every seven deaths in Europe was caused by TB
This document provides information on Potts spine, including its pathophysiology and management principles. It discusses how tuberculosis spreads to the spinal column, causing destruction of vertebral bodies and discs, collapse, and deformity. Risk factors, symptoms, investigations, classifications of lesions and paraplegia, medical management using antitubercular therapy, and indications for surgical treatment are summarized. The goals of surgery are decompression, deformity correction, and spinal stabilization.
The document discusses various types of spine infections including pyogenic osteomyelitis, discitis, fungal spine infections, and parasitic infections. It covers the definition, etiology, risk factors, clinical features, investigations, and management for each type. Key points include that pyogenic osteomyelitis most commonly affects the elderly or immunocompromised, discitis usually results from invasive procedures, fungal infections occur in immunocompromised patients, and echinococcus granulosus is a common parasitic infection in sheep-raising areas. Treatment involves antibiotics, surgery if needed, and addressing any underlying risks.
Tuberculosis of the hip joint is the second most common site of bone and joint TB after the spine. It typically affects people in their first three decades of life. The infection spreads from a primary focus such as the lungs to the hip joint via the bloodstream. It can initially involve different areas of the hip and pelvis before spreading to the joint. Patients present with hip pain, limping, and constitutional symptoms. Treatment involves anti-TB drugs along with rest, traction, and surgery if needed to address complications like joint destruction and deformity. Surgical options depend on the stage of disease and can include synovectomy, arthrodesis, osteotomy, or arthroplasty.
This document discusses tuberculosis of the hip. It begins with historical aspects noting Robert Koch's discovery of Mycobacterium tuberculosis in 1882. It then discusses the pathogenesis, pathology, clinical features, classification, diagnosis and management of TB of the hip. Key points include that TB of the hip is caused by hematogenous spread from a primary focus, most commonly presents in people aged 20-30 years old, and can be diagnosed through clinical features, imaging, bacteriological tests, and response to antitubercular treatment. Management involves absolute bed rest, traction, excision arthroplasty or arthrodesis depending on the stage of disease.
This document discusses spinal tuberculosis, including its presentation, imaging findings, and treatment. It describes the following key points:
- Spinal tuberculosis most commonly affects the thoracolumbar junction and presents with back pain and deformity. Imaging shows destruction of vertebral bodies.
- On MRI, paradiskal lesions narrow the intervertebral disk space while anterior lesions involve vertebral bodies under the anterior longitudinal ligament.
- Complications include paraplegia from epidural abscesses or vertebral collapse compressing the spinal cord.
- Treatment involves chemotherapy with antitubercular drugs. Surgery is indicated for neurological deficits, involvement of multiple vertebrae risking kyphosis, or if
Pott's disease nursing, medical, surgical managementsReynel Dan
Pott's disease, also known as tuberculosis of the spine, is caused by Mycobacterium tuberculosis infection of the vertebrae. Non-operative treatment involves antibiotics and immobilization for early or mild cases to halt progression. Surgery is required for abscesses, neurological issues, or cases that fail to improve with antibiotics. Nursing care focuses on immobilization, pain management, infection prevention, and monitoring for complications like neurological changes.
Osteoarticular tuberculosis is a common disease globally and in India, with involvement of bones and joints in around 30% of tuberculosis cases. It occurs most commonly in the spine, hip, knee, and other joints. It spreads hematogenously from a primary pulmonary or other visceral lesion. Spinal involvement often leads to deformities like gibbus formation or neurological complications like paraplegia. Treatment involves anti-tubercular medications like ATT along with rest and surgery if needed to drain abscesses or decompress nerves. Hip involvement can progress through stages of synovitis, arthritis, and advanced destruction requiring treatments like joint debridement, arthrodesis, or excision arthroplasty.
Tuberculosis of the spine commonly affects the thoracolumbar region. It presents with back pain and stiffness, cold abscesses, and neurological deficits in advanced cases. On radiographs, it shows vertebral body destruction, disc space narrowing, and paraspinal abscesses. CT and MRI are more sensitive in detecting bone and soft tissue involvement. Management involves anti-tubercular treatment along with surgery to decompress the spinal cord and restore stability if needed. Complications include paraplegia, deformity, and sinus tract formation.
Spinal tuberculosis can lead to serious deformities and neurological deficits if left untreated. It is most commonly caused by hematogenous spread from the lungs. Diagnosis involves clinical history, imaging studies like x-rays and MRI, and laboratory tests. Treatment consists of a combination of chemotherapy for at least 18 months and surgery if indicated to decompress the spinal cord and correct deformities. With early detection and proper management, spinal tuberculosis can be cured with good long-term outcomes.
This document discusses the management of Potts spine, or spinal tuberculosis. It begins by outlining the progression of spinal cord compression from the anterior column. Current concepts view uncomplicated spinal TB as predominantly a medical disease treated with anti-tubercular therapy (ATT) for 18-24 months. Surgery has specific indications like preventing or treating complications. Investigations include microscopy, culture, histopathology, and newer PCR-based tests. The roles of rest, bracing, and ambulation are discussed for proven cases. Surgical treatment goals include decompression, deformity correction, and stability.
Tuberculosis of spine and its complications nishanthGopi sankar
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.
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
This document provides an overview of tuberculosis of the skeletal system. It discusses the epidemiology and prevalence of skeletal tuberculosis and describes the various types of bone and joint involvement, including the spine, hip, knee, and shoulder. For each joint, it outlines the clinical presentations, radiological features, and stages of disease. It also reviews the pathology, diagnosis, treatment with anti-tubercular drugs, and surgical management of skeletal tuberculosis.
1. The document summarizes a seminar on tuberculosis of the hip joint. It discusses the history, epidemiology, pathogenesis, clinical features, stages, differential diagnosis, investigations and management of tuberculosis of the hip. 2. Key points include that tuberculosis of the hip is caused by Mycobacterium tuberculosis and spreads hematogenously from a primary focus. It presents with limping and pain and progresses through stages of synovitis, arthritis, advanced arthritis and destruction of the joint. Investigations include hematological tests, radiology and synovial fluid analysis.
Pott's disease, or spinal tuberculosis, is caused by Mycobacterium tuberculosis infection of the spine. It was first described by Percivall Pott in 1779. Key points:
1) India has a high prevalence of tuberculosis, with an estimated 2 million cases of spinal TB.
2) Spinal TB most commonly involves the thoracic spine, followed by the lumbar, cervical, and sacral regions.
3) Diagnosis is made through clinical history, physical exam, tuberculin skin test, imaging like x-rays, CT, and MRI showing vertebral body destruction and abscess formation.
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.
This document summarizes a post graduate seminar on skeletal tuberculosis. It discusses the etiology, pathogenesis, clinical presentation, investigations and management of skeletal tuberculosis. Mycobacterium tuberculosis commonly affects the lungs but can spread to bones and joints. Skeletal tuberculosis is transmitted through airborne droplets and causes chronic granulomatous lesions. Symptoms include low grade fever, pain and swelling. Investigations include x-rays showing bone destruction, biopsy to identify tubercles, and cultures. Treatment involves antitubercular drugs administered under DOTS guidelines for 6-8 months. Surgery may be needed for complications or neurological involvement. Proper treatment can cure tuberculosis in most cases.
This document discusses tuberculosis of the spine (Pott's disease). It notes that the spine is the most common site of bone involvement by tuberculosis, with the lower thoracic and lumbar vertebrae most often affected. Tuberculosis of the spine typically begins in the cancellous bone and spreads to adjacent vertebrae and discs. This can lead to abscesses that track through soft tissues, potentially causing epidural abscesses and spinal cord compression. Imaging plays an important role in evaluating the extent of bone and soft tissue involvement.
Spinal Tuberculosis by Dr. Monsif IqbalMonsif Iqbal
This document presents a case of spinal tuberculosis. It describes a 45-year-old female patient who presented with severe back pain of one week duration. Examination found tenderness in the lumbar spine and limited straight leg raise. Imaging including x-ray and MRI confirmed the diagnosis of spinal tuberculosis affecting L1 and L2. The document then provides details on the pathogenesis, clinical presentation, diagnosis, imaging features, complications and management of spinal tuberculosis.
Tuberculosis was popularly known as consumption for a long time. Scientists know it as an infection caused by M. tuberculosis. In 1882, the microbiologist Robert Koch discovered the tubercle bacillus, at a time when one of every seven deaths in Europe was caused by TB
This document provides information on Potts spine, including its pathophysiology and management principles. It discusses how tuberculosis spreads to the spinal column, causing destruction of vertebral bodies and discs, collapse, and deformity. Risk factors, symptoms, investigations, classifications of lesions and paraplegia, medical management using antitubercular therapy, and indications for surgical treatment are summarized. The goals of surgery are decompression, deformity correction, and spinal stabilization.
The document discusses various types of spine infections including pyogenic osteomyelitis, discitis, fungal spine infections, and parasitic infections. It covers the definition, etiology, risk factors, clinical features, investigations, and management for each type. Key points include that pyogenic osteomyelitis most commonly affects the elderly or immunocompromised, discitis usually results from invasive procedures, fungal infections occur in immunocompromised patients, and echinococcus granulosus is a common parasitic infection in sheep-raising areas. Treatment involves antibiotics, surgery if needed, and addressing any underlying risks.
Tuberculosis of the hip joint is the second most common site of bone and joint TB after the spine. It typically affects people in their first three decades of life. The infection spreads from a primary focus such as the lungs to the hip joint via the bloodstream. It can initially involve different areas of the hip and pelvis before spreading to the joint. Patients present with hip pain, limping, and constitutional symptoms. Treatment involves anti-TB drugs along with rest, traction, and surgery if needed to address complications like joint destruction and deformity. Surgical options depend on the stage of disease and can include synovectomy, arthrodesis, osteotomy, or arthroplasty.
This document discusses tuberculosis of the hip. It begins with historical aspects noting Robert Koch's discovery of Mycobacterium tuberculosis in 1882. It then discusses the pathogenesis, pathology, clinical features, classification, diagnosis and management of TB of the hip. Key points include that TB of the hip is caused by hematogenous spread from a primary focus, most commonly presents in people aged 20-30 years old, and can be diagnosed through clinical features, imaging, bacteriological tests, and response to antitubercular treatment. Management involves absolute bed rest, traction, excision arthroplasty or arthrodesis depending on the stage of disease.
This document discusses spinal tuberculosis, including its presentation, imaging findings, and treatment. It describes the following key points:
- Spinal tuberculosis most commonly affects the thoracolumbar junction and presents with back pain and deformity. Imaging shows destruction of vertebral bodies.
- On MRI, paradiskal lesions narrow the intervertebral disk space while anterior lesions involve vertebral bodies under the anterior longitudinal ligament.
- Complications include paraplegia from epidural abscesses or vertebral collapse compressing the spinal cord.
- Treatment involves chemotherapy with antitubercular drugs. Surgery is indicated for neurological deficits, involvement of multiple vertebrae risking kyphosis, or if
Pott's disease nursing, medical, surgical managementsReynel Dan
Pott's disease, also known as tuberculosis of the spine, is caused by Mycobacterium tuberculosis infection of the vertebrae. Non-operative treatment involves antibiotics and immobilization for early or mild cases to halt progression. Surgery is required for abscesses, neurological issues, or cases that fail to improve with antibiotics. Nursing care focuses on immobilization, pain management, infection prevention, and monitoring for complications like neurological changes.
Osteoarticular tuberculosis is a common disease globally and in India, with involvement of bones and joints in around 30% of tuberculosis cases. It occurs most commonly in the spine, hip, knee, and other joints. It spreads hematogenously from a primary pulmonary or other visceral lesion. Spinal involvement often leads to deformities like gibbus formation or neurological complications like paraplegia. Treatment involves anti-tubercular medications like ATT along with rest and surgery if needed to drain abscesses or decompress nerves. Hip involvement can progress through stages of synovitis, arthritis, and advanced destruction requiring treatments like joint debridement, arthrodesis, or excision arthroplasty.
Tuberculosis of the spine commonly affects the thoracolumbar region. It presents with back pain and stiffness, cold abscesses, and neurological deficits in advanced cases. On radiographs, it shows vertebral body destruction, disc space narrowing, and paraspinal abscesses. CT and MRI are more sensitive in detecting bone and soft tissue involvement. Management involves anti-tubercular treatment along with surgery to decompress the spinal cord and restore stability if needed. Complications include paraplegia, deformity, and sinus tract formation.
Spinal tuberculosis can lead to serious deformities and neurological deficits if left untreated. It is most commonly caused by hematogenous spread from the lungs. Diagnosis involves clinical history, imaging studies like x-rays and MRI, and laboratory tests. Treatment consists of a combination of chemotherapy for at least 18 months and surgery if indicated to decompress the spinal cord and correct deformities. With early detection and proper management, spinal tuberculosis can be cured with good long-term outcomes.
This document discusses the management of Potts spine, or spinal tuberculosis. It begins by outlining the progression of spinal cord compression from the anterior column. Current concepts view uncomplicated spinal TB as predominantly a medical disease treated with anti-tubercular therapy (ATT) for 18-24 months. Surgery has specific indications like preventing or treating complications. Investigations include microscopy, culture, histopathology, and newer PCR-based tests. The roles of rest, bracing, and ambulation are discussed for proven cases. Surgical treatment goals include decompression, deformity correction, and stability.
Tuberculosis of spine and its complications nishanthGopi sankar
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.
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
This document provides an overview of tuberculosis of the skeletal system. It discusses the epidemiology and prevalence of skeletal tuberculosis and describes the various types of bone and joint involvement, including the spine, hip, knee, and shoulder. For each joint, it outlines the clinical presentations, radiological features, and stages of disease. It also reviews the pathology, diagnosis, treatment with anti-tubercular drugs, and surgical management of skeletal tuberculosis.
1. The document summarizes a seminar on tuberculosis of the hip joint. It discusses the history, epidemiology, pathogenesis, clinical features, stages, differential diagnosis, investigations and management of tuberculosis of the hip. 2. Key points include that tuberculosis of the hip is caused by Mycobacterium tuberculosis and spreads hematogenously from a primary focus. It presents with limping and pain and progresses through stages of synovitis, arthritis, advanced arthritis and destruction of the joint. Investigations include hematological tests, radiology and synovial fluid analysis.
Pott's disease, or spinal tuberculosis, is caused by Mycobacterium tuberculosis infection of the spine. It was first described by Percivall Pott in 1779. Key points:
1) India has a high prevalence of tuberculosis, with an estimated 2 million cases of spinal TB.
2) Spinal TB most commonly involves the thoracic spine, followed by the lumbar, cervical, and sacral regions.
3) Diagnosis is made through clinical history, physical exam, tuberculin skin test, imaging like x-rays, CT, and MRI showing vertebral body destruction and abscess formation.
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.
TB of the spine commonly affects the thoracic and lumbar regions. It spreads hematogenously and causes destruction of vertebral bodies. Common presentations include chronic back pain and deformities. Advanced cases may involve neurological deficits due to spinal cord compression. Diagnosis involves imaging tests like x-rays and MRI. Treatment is with anti-TB medications along with rest. Surgery is indicated for complications like paraplegia. Prognosis depends on factors like age, duration of symptoms and severity of neurological involvement.
This document discusses tuberculosis of the spine. Some key points:
- Spinal tuberculosis most commonly affects the dorsal spine in the first three decades of life. It spreads hematogenously from a primary focus.
- Pathology involves formation of tubercles and caseation necrosis, which can lead to bone destruction and deformity like kyphosis.
- Presentation includes non-specific symptoms like back pain as well as neurological deficits in some cases. Investigations include imaging like X-ray and MRI to identify bone changes and abscesses.
- Treatment has evolved from early surgical drainage to current emphasis on early diagnosis and medical treatment with antibiotics to cure the infection while preserving spinal function and structure.
1) Tuberculosis of the spine is the most common form of skeletal tuberculosis, frequently affecting the dorsal spine.
2) It is caused by hematogenous spread of Mycobacterium tuberculosis from a primary focus. This can lead to destruction of vertebral bodies and discs, collapse, deformity, and neurological deficits in advanced cases.
3) Treatment has evolved tremendously from ancient herbal preparations and hot iron drainage to modern multi-drug anti-tubercular regimens with aggressive surgical management to prevent deformity and paralysis when needed.
Pott's disease, or tuberculosis of the spine, is a form of extrapulmonary TB that affects the bones and discs of the spine. It spreads hematogenously from the lungs and infects two or more adjacent vertebrae. This can lead to vertebral collapse, kyphosis, and spinal damage. Symptoms include back pain and limited spinal movement. Diagnosis involves blood tests, x-rays showing vertebral destruction, and biopsy. Treatment is with anti-TB drugs to eliminate the infection along with pain management and occasionally surgery. Physiotherapy can help strengthen muscles and reduce pain but does not treat the underlying disease. Prognosis depends on successful treatment of the TB infection to prevent recurrence.
Treatment of spinal tuberculosis - presented at the Postgraduate teaching course held at KEM Hospital, Mumbai in March 2016.
The talk highlights steps in diagnostic workup and treatment algorithm for management of spinal tuberculosis.
Please see notes attached to clinical slides. They contain details about clinical presentation and treatment approach chosen for the case presented
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
The document discusses spinal tuberculosis, noting that it causes delays in diagnosis, long recovery periods, and high costs. Key points include:
- Paralysis occurs in up to 50% of spinal tuberculosis patients.
- Early diagnosis, expedient treatment, aggressive surgery, and preventing deformity lead to the best outcomes.
- Diagnosis relies on tests like tuberculin skin tests, imaging like MRI to identify bone destruction and abscesses, and microscopy and culture of samples.
- Patterns of bone involvement include paradiscal, central, anterior, and appendiceal lesions.
- Complications include paralysis, cold abscesses, deformities, and secondary infections.
This document provides an overview of tuberculosis of the spine. Some key points:
- Spinal tuberculosis accounts for 50% of osteoarticular tuberculosis cases and commonly presents with back pain.
- Diagnosis relies on clinical exam, imaging, and molecular/histological tests since culture has low yield from bone. MRI is often diagnostic.
- Treatment involves antitubercular drug therapy for 9-12 months. Surgery is indicated for debridement of active lesions, neurological deficits, or deformity/instability in healed cases.
- Surgical approaches include anterior, posterior, and combined. Posterior-only approaches using instrumentation are now preferred for deformity correction and stabilization.
This study compared short-course radiotherapy to long-course chemoradiation for patients with T3 rectal cancer. It found that long-course treatment resulted in a lower risk of local tumor recurrence, though the difference was not statistically significant. Both treatments had similar rates of distant tumor recurrence and overall survival. Long-course treatment seemed to provide a greater benefit for distal tumors, with fewer local recurrences, but again the difference was not statistically significant due to the small number of distal tumors.
The document outlines criteria for malignant giant cell tumor of the tendon sheath. Bertoni et al established criteria for diagnosing malignant pigmented villonodular synovitis (PVNS) based on histologic appearance and whether benign disease preceded or coexisted with cancer. The criteria included a nodular, solid infiltrative pattern; large, plump cells with deep eosinophilic cytoplasm and indistinct borders; large nuclei with prominent nucleoli; necrotic areas; and absence of a zonal pattern of maturation.
Articulo observacion importantes carotid body tumorMaynor Lopez
This study analyzed 49 carotid body tumor (CBT) resections in 39 patients over 25 years to assess outcomes. A neck mass was the most common presenting symptom. Complications occurred in 27% of cases, predominantly temporary nerve palsies which were more likely with larger tumors. Malignant disease was present in 15% of cases. During long-term follow up (average 11 years), 6 patients developed new paragangliomas, all with familial disease. Early resection of CBTs is recommended while still small to minimize risks, and lifelong follow up is essential in familial cases to screen for new tumors.
This study retrospectively analyzed 163 patients treated for spondylodiscitis (spinal infection) between 1992-2000. Patients were divided into 3 treatment groups:
Group A (70 patients) received non-operative treatment including antibiotics and bracing. 8 later required surgery.
Group B (56 patients) underwent posterior decompression alone. 24 later required additional surgery for debridement and stabilization.
Group C (37 patients) received decompression and internal stabilization. Only 6 later required re-operation.
Non-operative treatment was effective for most patients. Decompression alone had a higher re-operation rate compared to decompression with internal stabilization. Overall, surgical treatment improved neurological outcomes compared to non-
Abstract—Colorectal cancer is leading cancer-related public health problem. This study was conducted to determine the effect of High-Dose-Rate intraluminal brachytherapy (HDR-BT) with or without interstitial brachytherapy during neoadjuvant chemoradiation for locally advanced rectal cancer. This randomized contrial was conducted on 28 patients attended with locally advanced rectal cancer (T3, T4 or N+) treated initially with concurrent capecitabine (800 mg/m2 twice daily for 5 days per week) and pelvic external beam radiation therapy (45Gy in 25 Fractions) after one week MRI for all patients; received intraluminal HDR-BT with 4Gy x 2 Fractions with one week interval for those had gross residual disease within 1cm of rectal wall and receiveed intraluminal and interstitial brachytherapy with 4Gy x 2 Fractions with one week interval for those had gross residual disease far from 1cm of rectal wall. All patients underwent surgery within 4-8 week after completion of neoadjuvant therapy. In the control group which were not randomized, twenty-eight patients underwent neoadjuvant chemoradiation (45Gy in 25 Fraction with concurrent capecitabine 800mg/m2 twice daily for 5 days per week) followed by surgery. It was found that in HDR-BT group pathologic complete response (pCR), pathologic partial response (pPR) and pathologic response rates (pCR+pPR) based on AJCC TNM staging for colorectal cancer were %35.7, %35.7, and %71.4 respectively. The pCR, pPR, and pRR were %25, %17, and %42 in the control group respectively. pCR, pPR, and pRR were improved with HDR-BT. However, only response rate improvement was statistically significant (p=0.031). There was no a statistically significant difference in the complications between the two groups (p > 0.05). So it can be concluded that HDR intraluminal with or without interstitial brachytherapy may be an effective method of dose escalation technique in neoadjuvant chemoradiation therapy of locally advanced rectal cancer with higher response rate and manageable side effects.
This study evaluated outcomes of 28 patients with intracranial meningiomas treated with hypofractionated radiosurgery. Most tumors were treated with 22.5-30 Gy delivered in 5 fractions. With a mean follow up of 32.6 months, the local tumor control rate was 100% with only one instance of marginal progression. Symptoms improved or resolved in over 66% of patients who originally presented with symptoms. Side effects occurred in 4 patients but the permanent morbidity rate was low at 3.5%. Hypofractionated radiosurgery provided high tumor control with a low risk of side effects, even for large tumors greater than 9 cm3.
A 79-year-old man presented with stage IVA squamous cell carcinoma of the head and neck. He was treated with intensity modulated radiotherapy plus concurrent cetuximab, achieving a complete response with manageable toxicity. Follow-up imaging at 9 months showed no evidence of recurrence.
Management of drug resistant tb patientsBassem Matta
This study evaluated the treatment outcomes of the first cohort of 168 multi-drug resistant tuberculosis (MDR-TB) patients treated in Egypt. Of these, 65 patients completed treatment. Factors associated with treatment success included younger age, nonsmoking status, no history of previous second-line drug use, less lung tissue destruction on x-rays, and sputum culture conversion within 3 months of starting treatment. The treatment success rate was 68% with failure, default and mortality rates of 9%, 6% and 17% respectively. Recommendations include decreasing unnecessary second-line drug use and ensuring direct observation of treatment for all MDR-TB patients.
Effectiveness of gefitinib as additional radiosensitizer to conventional chem...Alexander Decker
This randomized controlled study evaluated the effectiveness of adding the tyrosine kinase inhibitor gefitinib to conventional chemoradiation for locally advanced head and neck squamous cell carcinoma. 104 patients were randomized to receive either gefitinib plus cisplatin-based chemoradiation (experimental arm) or cisplatin-based chemoradiation alone (control arm). The study found a statistically significant difference in overall response rates favoring the gefitinib arm, as well as improved disease-free survival. However, the gefitinib arm also resulted in higher rates of manageable toxicities like dermatitis, mucositis, and diarrhea.
11.[42 53]effectiveness of gefitinib as additional radiosensitizer to convent...Alexander Decker
This randomized controlled study evaluated the effectiveness of adding the tyrosine kinase inhibitor gefitinib to concurrent chemoradiation for locally advanced head and neck squamous cell carcinoma. Between 2008-2011, 104 patients were randomized to receive either cisplatin-based chemoradiation plus daily gefitinib (experimental arm) or cisplatin-based chemoradiation alone (control arm). The study found that the experimental arm had a statistically significant higher overall response rate compared to the control arm. Disease-free survival also favored the experimental arm. However, the experimental arm resulted in more grade 2-3 dermatitis, mucositis and diarrhea. Adding gefitinib to chemoradiation improved outcomes
11.effectiveness of gefitinib as additional radiosensitizer to conventional c...Alexander Decker
This randomized controlled study evaluated the effectiveness of adding the tyrosine kinase inhibitor gefitinib to concurrent chemoradiation for locally advanced head and neck squamous cell carcinoma. Between 2008-2011, 104 patients were randomized to receive either cisplatin-based chemoradiation plus daily gefitinib (experimental arm) or cisplatin-based chemoradiation alone (control arm). The overall response rate was significantly higher in the gefitinib arm compared to the control arm. Disease-free survival also favored the gefitinib arm. However, the gefitinib arm resulted in more grade 2-3 dermatitis, mucositis and diarrhea. Adding gefitinib to chem
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...daranisaha
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...JohnJulie1
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...eshaasini
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...NainaAnon
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Clinics of Oncology | Oncology Journals | Open Access JournalEditorSara
Clinics of OncologyTM (ISSN 2640-1037) - Impact Factor 1.920* is a medical specialty that focuses on the use of operative techniques to investigate and resolve certain medical conditions caused by disease or traumatic injury.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
In this retrospective study we enrolled patients with upper rectal or sigmoid junction locally advanced tumors (stages II-III). At the first Institution patients received NCRT followed by surgery (study group); at the second Institution patients were referred to upfront surgery (control group). Overall survival was the main endpoint of the analysis. Local relapse and other clinical variables were also analyzed.
LANDMARK TRIALS IN BREAST CANCER SURGERY PART 1.pptxmasoom parwez
The document summarizes key landmark breast cancer surgery trials. The NSABP B-04 trial from 1971-1974 showed that radical mastectomy provided no survival benefit over total mastectomy for node-negative or node-positive breast cancer. The NSABP B-06 trial from 1976-1984 established breast-conserving therapy with lumpectomy and radiation as an equivalent option to mastectomy. The Cancer and Leukemia Group B 9343 trial from 1994-1999 showed that radiation could be omitted in selected older patients receiving lumpectomy and tamoxifen. The NSABP B-32 and ACOSOG Z0011 trials established sentinel lymph node biopsy as sufficient for staging clinically node-negative breast cancer.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
2. SPINAL TUBERCULOSIS
:ROLE OF SURGERY
KHALED ABDEEN,AHMED AZAB* ,HISHAM
ABORAHMA*
ALEXANDRIA UNIVERSITY
* ALMONEFIA UNIVERSITY-EGYPT
3. Epidemiology
• 8.8 million new cases of TB/year .
• Developing counteries account for nearly 75% of
all case of TB .
• TB spine accounts for 2% of all cases .
• 50% of skeletal TB .
• Thorcic and thoracolumbar regions mostly
affected .
• Cervical TB accounts 3-9 % .
• Skip lesions 7-10 % .
4. TWO Groups
• Radical surgery patients :
• Progressive neurological deficits .
• Abscess .
• Kyphosis .
• Interactable pain .
• ATT alone patients .
5. • 52 TB spine patients treated surgically .
• 2001-2012.
• Age: 12-70 years .
• 32 male:20 females
• Follow up between 1-10 years .
• All patients received anti tuberculous treatment .
• Plain x ray , MRI , ESR .
6.
7.
8. Group A. The lesion was limited to the anterior column, with
no abnormal signals on MRI at, or posterior to, the pedicles.
No deformity was present. The lesion was either paradiscal or
central body in type
9. Group B.
The lesions involved the anterior and posterior columns at
the same levels and were unstable with an associated
kyphosis .
12. J. S. Mehta, MS Orth, D Orth, MCh Orth, Orthopaedic Specialist
Registrar JBJS VOL. 83-B, NO. 6, AUGUST 2001
13. • Objective : to evaluate different surgical modalities in the
treatment of spinal tuberculosis and its outcome as regard
neurological improvement ,bony fusion ,and spinal
stability .
• This study included 25 patients with spinal tuberculosis [10
of them with cervical affection ,and 15 with dorsolumbar
tuberculosis] ,their mean age 38.5 ys [average 28 –56 ys ]
with an average follow up period of 15 months [12- 36
months ].This study included two groups ,the cervical
group[C3-7] included 10 patients and the dorsolumbar
group included 15 patients .All of our patients presented
with neurologic deficits for short period with average 2-6
months.All patients received antituberculous medications
for 9-12 months.
14. Diagnosis
• Culture , antigen demonstration, serology
tests ,and polymerasechain reaction are of
high priority .
• The polymerase chain reaction has
facilitated the diagnosis and treatment .
15. Treatment
• Effective chemotherapy for spinal
tuberculosis is the gold standard and
mainstay of treatment and all other methods
of treatment are regarded as
supplementary .
• Triple chemotherapy should be given for 12
months [ rifampicin, isoniazide , and
pyazinamide ]
16. RESULTS
• Microbiological and histopathological studies of the
operative specimen revealed specific, granulomatous
infection consistent with tuberculosis. All patients had an
increased erythrocyte sedimentation rate before anti-
tuberculous medication returnedto normal within 6 months
after medication .
• Neurological outcome:
Neurological deficits were improved at final up
examination as defined by the scoring system of Frankel .
two patients of grade B before surgery , had improvement
to grade C and grade D , of the 12 with grade C , 8 had
complete recovery to grade E , and 4 had improvement to
grade D , 5patients with grade D had complete recovery to
grade E .
17. RESULTS
• Radiological evaluation: x-ray showed the destruction of contiguous
vertebral bodies with involvement of the disc space between them in
23 patients(paradiscal type , collapsed C4 vertebral body (central type)
in two patients and the presence of widened prevertebral space was
evident in all patients . CT delineated bone involvement and
paravertebral abscess extension . MRI was performed in all cases to
show the epidural abscess and degree of spinal cord compression . (fi.
• Bony Fusion:
Clinical and radiological evidence of stable fusion observed in all
patients, with one segment fusion was obtained at average of 4 months
and 2 segments fusion was obtained at average of 5 months (3.5 to 6
months) .
• Angle of kyphosis:In the dorsolumbar groupThe average of pre-
operative Kyphosis angle was 36 degrees (range 32-48 degrees)and
the average angle of kyphosis in last follow-up was 17 degrees (range
13-19 degrees) while in the cervical group, there was bone destruction
but no significant kyphotic deformity
18. • The cervical group: 9 of them treated by anterior
cervical approach for decompression followed by
fixation by iliac bone graft and cervical plating
,one patient with C3 tuberculosis managed by
single stage- combined anterior decompression
and fusion by iliac bone graft followed by
posterior occipitocervical fixation by Ransford
Loop . There was an improvement in the Nurick
grade from a preoperative mean of 2.5 to mean 0.3
at the last follow up .
• The dorsolumbar group: 6 cases managed by
posterior instrumentation [4 cases segmental
fixation by transpedicular screws and 2 cases with
Hartshill rectangle with sublaminar wires] ,
anterior approach in 7 cases, and another 2 cases
circumferential fusion were done at one operative
setting.
19.
20.
21.
22. C3 TUBERCULOSIS
APPROACH
COMBINED SINGLE STAGE
{ANTERIOR&POSTERIOR}
29. RESULTS
• All patients showed improved neurological
outcome.All of them had solid fusion within
average 6 months .
• In the dorsolumbar group ,angle of
kyphosis was improved in all patients ,
average angle of kyphosis preoperative was
36 degree and at the late follow up ,it was
17 degree and no implant complications .
30. CONCULSIONS
• Early surgical intervention ,either posterior
rigid fixation ,anterior interbody fusion or
circumferential fusion plus chemotherapy
were found to help in arresting the disease
providing satisfactory stabilization ,as well
as preventing progression of kyphosis and
correcting kyphosis .there is no additional
risk related to the use of an implant even if
large quantities of pus were present
31.
32.
33. SPINAL TUBERCULOSIS
:ROLE OF SURGERY
KHALED ABDEEN,AHMED AZAB* ,HISHAM
ABORAHMA*
ALEXANDRIA UNIVERSITY
* ALMONEFIA UNIVERSITY-EGYPT
34. Epidemiology
• TB spine accounts for 2% of all cases .
• 50% of skeletal TB .
• Thorcic and thoracolumbar regions mostly
affected .
• Cervical TB accounts 3-9 % .
• Skip lesions 7-10 % .
35. • Objective : to evaluate different surgical modalities in the
treatment of spinal tuberculosis and its outcome as regard
neurological improvement ,bony fusion ,and spinal
stability .
• This study included 25 patients with spinal tuberculosis [10
of them with cervical affection ,and 15 with dorsolumbar
tuberculosis] ,their mean age 38.5 ys [average 28 –56 ys ]
with an average follow up period of 15 months [12- 36
months ].This study included two groups ,the cervical
group[C3-7] included 10 patients and the dorsolumbar
group included 15 patients .All of our patients presented
with neurologic deficits for short period with average 2-6
months.All patients received antituberculous medications
for 9-12 months.
36.
37.
38.
39.
40. Diagnosis
• Culture , antigen demonstration, serology
tests ,and polymerasechain reaction are of
high priority .
• The polymerase chain reaction has
facilitated the diagnosis and treatment .
41. Treatment
• Effective chemotherapy for spinal
tuberculosis is the gold standard and
mainstay of treatment and all other methods
of treatment are regarded as
supplementary .
• Triple chemotherapy should be given for 12
months [ rifampicin, isoniazide , and
pyazinamide ]
42. Antituberculous treatment
• All received antituberculous chemotherapy starting two
• weeks before surgery. Pyrazinamide was given for the first
• Three months only.
• Treatment with ethambutol, rifampicin, isonicotinic acid
hydrazide and folic acid supplement continued for a total 9
months .
• Patients with resistant atypical mycobacterial strains were
treated on the basis of microbiological advice, the reserve
drugs being kanamycin and ciprofloxacillin
43. RESULTS
• Microbiological and histopathological studies of the
operative specimen revealed specific, granulomatous
infection consistent with tuberculosis. All patients had an
increased erythrocyte sedimentation rate before anti-
tuberculous medication returnedto normal within 6 months
after medication .
• Neurological outcome:
Neurological deficits were improved at final up
examination as defined by the scoring system of Frankel .
two patients of grade B before surgery , had improvement
to grade C and grade D , of the 12 with grade C , 8 had
complete recovery to grade E , and 4 had improvement to
grade D , 5patients with grade D had complete recovery to
grade E .
44. RESULTS
• Radiological evaluation: x-ray showed the destruction of contiguous
vertebral bodies with involvement of the disc space between them in
23 patients(paradiscal type , collapsed C4 vertebral body (central type)
in two patients and the presence of widened prevertebral space was
evident in all patients . CT delineated bone involvement and
paravertebral abscess extension . MRI was performed in all cases to
show the epidural abscess and degree of spinal cord compression . (fi.
• Bony Fusion:
Clinical and radiological evidence of stable fusion observed in all
patients, with one segment fusion was obtained at average of 4 months
and 2 segments fusion was obtained at average of 5 months (3.5 to 6
months) .
• Angle of kyphosis:In the dorsolumbar groupThe average of pre-
operative Kyphosis angle was 36 degrees (range 32-48 degrees)and
the average angle of kyphosis in last follow-up was 17 degrees (range
13-19 degrees) while in the cervical group, there was bone destruction
but no significant kyphotic deformity
45. • The cervical group: 9 of them treated by anterior
cervical approach for decompression followed by
fixation by iliac bone graft and cervical plating
,one patient with C3 tuberculosis managed by
single stage- combined anterior decompression
and fusion by iliac bone graft followed by
posterior occipitocervical fixation by Ransford
Loop . There was an improvement in the Nurick
grade from a preoperative mean of 2.5 to mean 0.3
at the last follow up .
• The dorsolumbar group: 6 cases managed by
posterior instrumentation [4 cases segmental
fixation by transpedicular screws and 2 cases with
Hartshill rectangle with sublaminar wires] ,
anterior approach in 7 cases, and another 2 cases
circumferential fusion were done at one operative
setting.
46.
47. C3 TUBERCULOSIS
APPROACH
COMBINED SINGLE STAGE
{ANTERIOR&POSTERIOR}
52. RESULTS
• All patients showed improved neurological
outcome.All of them had solid fusion within
average 6 months .
• In the dorsolumbar group ,angle of
kyphosis was improved in all patients ,
average angle of kyphosis preoperative was
36 degree and at the late follow up ,it was
17 degree and no implant complications .
53. CONCULSIONS
• Early surgical intervention ,either posterior
rigid fixation ,anterior interbody fusion or
circumferential fusion plus chemotherapy
were found to help in arresting the disease
providing satisfactory stabilization ,as well
as preventing progression of kyphosis and
correcting kyphosis .there is no additional
risk related to the use of an implant even if
large quantities of pus were present
54.
55.
56. • When tuberculosis is suspected, a purified protein
derivative skin test will be positive in 95% of cases.
• Immunosuppressed patients may be anergic, leading to
falsenegative results.
• Recently, polymerase chain reaction testing has been used
to amplify the microbial genome for identification within
a few hours when standard culture methods fail.
• Isolation of an organism is necessary for appropriate
antibiotic treatment, especially for nonsurgical
management; however, definitive identification of the
pathogen can only be accomplished using tissue cultures
obtained directly from the site of infection.
57. • In the case of Pott disease, treatment lasts for a mean of 12
months, with variations in duration and type of chemotherapy
depending on regional resistance patterns.
Initially, isoniazid, ethambutol, rifampin, and pyrazinamide are
prescribed for the first 2 months. If no information o
sensitivities is available, isoniazid, ethambutol, and rifampin
are continued for 12 months. If sensitivities are known, two
drugs can be used. If isoniazid and rifampin are active, they
are continued for 12 months. If other combinations are used,
therapy is extended to 18 to 24 months. In
immunocompromised patients, indinavir and rifabutin are
added.