Tuberculosis, or TB, is an infectious disease usually caused by the Mycobacterium tuberculosis bacteria that typically affects the lungs. It can spread to other parts of the body as well. Pott's disease is a form of TB that affects the spine, usually spreading there from the lungs. It most commonly impacts the lower thoracic and upper lumbar regions. Symptoms can include back pain, nerve problems, and bone destruction that leads to deformity if left untreated. Plain radiography is useful for diagnosis and shows lytic bone destruction, vertebral wedging or collapse.

1. By: MIT. Otim Brian
TB Spine

2. Tuberculosis (TB) is an infectious disease usually caused by
Mycobacterium tuberculosis (MTB) bacteria.
Tuberculosis generally affects the lungs, but it can also affect other
parts of the body. Most infections show no symptoms, in which case
it is known as latent tuberculosis.
Around 10% of latent infections progress to active disease which, if
left untreated, kill about half of those affected.

3. Typical symptoms of active TB are chronic cough with blood-containing
mucus, fever, night sweats, and weight loss.
It was historically referred to as consumption due to the weight loss
associated with the disease. Infection of other organs can cause a wide
range of symptoms.
.

4. Pott disease is tuberculosis of the spine, usually due to
haematogenous spread from other sites, often the lungs.
The lower thoracic and upper lumbar vertebrae areas of the spine are
most often affected.
Potts Disease
The disease is named after Percivall Pott, the British surgeon who first
described it in the late 18th century

8. Common Site of Infection
Why?
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9. The spine is involved due to hematogenous spread that can
occur via both arteries and veins, resulting in different
patterns of infection.
Pathology

14. Spread through the anterior arterial arcade that richly
supplies the subchondral paradiscal bone results in
infection anterosuperiorly and anteroinferior, adjacent to the
disc.
Infection then spreads beneath the longitudinal ligaments
and can lead to infection of adjacent vertebral bodies.
Gradual anterior collapse typically results in an acute
kyphotic or gibbus deformity. This angulation, coupled with
epidural granulation tissue and bony fragments, can lead to
cord compression.
Anteroir involvement

17. Central Involment
Spread via the venous plexus of Batson typically results in infection
arising centrally within the vertebral body.
This is more common in older individuals.
Single vertebral body is affected.
LLytic area develope within the vertebral body resulting to balooning of
vertebral body mimicking atumor.
Gradual collapse can result in vertebra plana and acute kyphotic or
gibbus deformity. This angulation, coupled with epidural granulation
tissue and bony fragments, can lead to cord compression.

19. Posteroir involment
Posterior involvement, also known as an appendiceal pattern is
also due to venous hematogenous spread via the posterior
venous plexus.

20. Synovial Invovlement
Synovial involvement is relatively rare but can be seen involving
facet joints and atlantoaxial and atlanto-occipital joints.

21. In late-stage spinal tuberculosis, large paraspinal
abscesses can develop without severe pain or frank pus
or prominent inflammatory signs and symptoms; thus "
cold abscess".
Cold abscess

31. Spine is the most common site of skeletal tuberculosis.
Radiographic manifestations of tuberculous spondylitis include
intraosseous and paraspinal abscess formation, subligamentous
spread of infection, vertebral body destruction and collapse, and
extension into the spinal epidural space. Significant instability and
deformity of the spine can result, mandating prompt diagnosis and
treatment to prevent permanent neurologic damage.
Radiological fratures

32. Plain Radiography
•
•
•
Lytic destruction of anteroir portion of vertebral
body
Increased anterior wedging
Collapse of vertebral body

45. Although Schmorl’s nodes can develop anywhere on the spinal
column, they primarily occur on the upper lumbar spine. The
nodes typically affect the lower, or inferior, endplate of thoracic
vertebrae and the upper, or superior, endplate of lumbar
vertebrae.
Schmorl's nodes are protrusions of the nucleus pulposus
(materials of intervertebral disc) of the intervertebral disc
through the vertebral body endplate and into the adjacent
vertebra.
Schmorl's disease

47. Scheuermann disease, also known as juvenile kyphosis,
juvenile discogenic disease, or vertebral epiphysitis, is a
common condition which results in kyphosis of the
thoracic or thoracolumbar spine. The diagnosis is usually
made on plain radiograph.
Scheuermann disease

48. To apply the label of classical Scheuermann disease, the Sorensen
criteria need to be met.
1. Thoracic spine kyphosis >40° (normal 25-40°) or
2. Thoracolumbar spine kyphosis >30° (normal ~0°)
and
3. At least 3 adjacent vertebrae demonstrating wedging of >5°
Other signs include:
vertebral endplate irregularity due to extensive disc invagination
intervertebral disc space narrowing, more pronounced anteriorly

49. Scheuermann's disease. a Lumbar spine X-ray showing
vertebral wedging, endplate irregularities, Schmorl's nodes,
and narrowing of some of the disk spaces. b Similar findings
on sagittal T1W MRI

54. Habakkuk 2:4 "The just shall live by faith"
Final word

55. Reporter: XX
THANK YOU