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.
Avascular necrosis (AVN) of the femoral head is a pathologic process that results from interruption of blood supply to the bone. AVN of the hip is poorly understood, but this process is the final common pathway of traumatic or nontraumatic factors that compromise the already precarious circulation of the femoral head. Femoral head ischemia results in the death of marrow and osteocytes and usually results in the collapse of the necrotic segment
Infections of spine
Spine infection
Tuberculosis of spine
Differential diagnosis of infections of spine
Spinal tuberculosis
Pyogenic infections of spine
Fungal infections of spine
Spinal Brucellosis
Management of Spinal tuberculosis
Bacterial infections of spine
Avascular necrosis (AVN) of the femoral head is a pathologic process that results from interruption of blood supply to the bone. AVN of the hip is poorly understood, but this process is the final common pathway of traumatic or nontraumatic factors that compromise the already precarious circulation of the femoral head. Femoral head ischemia results in the death of marrow and osteocytes and usually results in the collapse of the necrotic segment
Infections of spine
Spine infection
Tuberculosis of spine
Differential diagnosis of infections of spine
Spinal tuberculosis
Pyogenic infections of spine
Fungal infections of spine
Spinal Brucellosis
Management of Spinal tuberculosis
Bacterial infections of spine
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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
Tuberculosis of spine
1. By Dr Shahid Latheef
Department of Orthopaedics
Yenepoya Medical College
Mangalore
2. • The primary problems today are :
The delay in diagnosis (average 3months)
The long recovery period (average 12months)
The great cost of treating such infections.
Resurgence in HIV patients.
• Paralysis is reported to occur in up to 50% of
patients with spinal infections .
3. • Early diagnosis
• Expeditious medical treatment
• Aggressive surgical approach
• Prevent deformity
• Best outcome
“The captain of the men of death”
4. • Presentation depends on :
• Stage of disease
• Site
• Presence of complications such as neurologic deficits,
. abscesses, or sinus tracts.
• Average duration of symptoms at the time of diagnosis is 3 – 4
months.
• Back pain is the earliest & most common symptom.
• Constitutional symptoms.
• Neurologic symptoms (50 % of cases).
5. • Physical examination of the spine :
• Localised tenderness and paravertebral muscle spasm,
• Kyphotic deformity
• Cold abscess / swelling / sinus tract
• Cervical spine TB is a less common presentation,
characterized by pain & stiffness with dysphagia / stridor more
common in lower cervical spine involvement
6. LAB STUDIES
• Mantoux / Tuberculin skin test
• ESR may be markedly elevated (neither specific nor
reliable).
• ELISA : for antibody to mycobacterial antigen-6 ,
sensitivity of 60 – 80%.
• PCR
7. • Microbiology studies to confirm diagnosis
• Ziehl-Neelsen staining: Quick and inexpensive method.
• Bone tissue or abscess samples stain for acid-fast
bacilli (AFB), & isolate organisms for culture & drug
susceptibility.
• Culture results - few weeks.
• Positive only in 50% of cases.
9. • More than 50% of bone has to be destroyed.
• May take approximately six months.
• The classic roentgen triad in spinal tuberculosis is
primary vertebral lesion
disc space narrowing and
paravertebral abscess.
10. • Typical tubercular spondylitic features in long standing
paraspinal abscesses
a} produce concave erosions around the anterior margins
of the vertebral bodies producing a scalloped appearance
called the Aneurysmal phenomenon.
b} fusiform paraspinal soft tissue shadow with calcification
in few
• Skip lesions as involvement of non contiguous vertebrae (7 –
10 % cases).
11. • DEFORMITIES:
. Anterior wedging
. Gibbous deformity.
. Vertebra plana = single collapsed
vertebra
12. • Patterns of bony destruction.
• Calcifications in abscess (pathognomic for Tb)
• Regions which are difficult to visualize on plain films, like :
1. Cranio-vertebral junction (CVJ)
2. Cervico-dorsal region,
3. Sacrum
4. Sacro-iliac joints.
5. Posterior spinal tuberculosis because lesions less
than 1.5cm are usually missed due to overlapping of shadows
on x rays.
13. • Lack of ionizing radiation, highcontrast resolution & 3D
imaging.
• Detect marrow infiltration in vertebral bodies, leading to early
diagnosis.
• Changes of diskitis
• Assessment of extradural abscesses / subligamentous spread.
• Skip lesions
• Spinal cord involvement.
• Spinal arachanoiditis.
14. USG
- to find out primary in abdomen
- Detect cold abscess
- Guided aspiration
Radionucleotide Scan T 99m
• Increased uptake in up to 60 per cent patients with active
tuberculosis.
• >= 5mm lesion size can be detected.
• Avascular segments and abscesses show a cold spot due to
decreased uptake.
• Highly sensitive but nonspecific.
• Aid to localise the site of active disease and to detect
multilevel involvement
15. • Patterns of Vertebral Involvement
• The primary focus of infection in the spine can be either
in the vertebral body or in the posterior elements.
•
• Four patterns :
Paradiscal ( Commonest)
Central
Anterior, &
Appendiceal
16.
17. 1. Paradiscal Lesions:
• Most common
• Adjacent to the I/V disc leading to a narrowing of the disc
space.
• Destruction of subchondral bone with subsequent herniation of
the disc into the vertebral body or by direct involvement of the
disc.
• MR imaging shows low signal on T1-weighted images and high
signal on T2-weighted images in the endplate, narrowing of the
disc, and large paraspinal and sometimes epidural abscesses.
18.
19. 2. ANTERIOR TYPE…
• Subperiosteal lesion under the ALL.
• Pus spreads over multiple vertebral segments
• Strips the periosteum and ALL from the anterior
surface of the vertebral bodies.
• Periosteal stripping renders the vertebrae avascular
and susceptible to infection.
• Both pressure and ischemia combine to produce
anterior scalloping
20. • Collapse of the VB & diminution of the disc space is usually
minimal & occurs late.
• More common in thoracic spine in children.
• MR imaging shows the subligamentous abscess,
preservation of the discs, and abnormal signal involving
multiple vertebral segments representing vertebral
tuberculous osteomyelitis.
21.
22. 3. Central Lesions :
• Centred on the vertebral body.
Batson‟s venous plexus or posterior
vertebral artery.
• Disc not involved.
• Vertebral collapse occur - vertebra plana
appearance.
• MR - signal abnormality of the vertebral body
with preservation of the disc.
• DD: Appearance is indistinguishable from that of
lymphoma or metastasis.
23.
24. 4) Appendicial lesion
• Isolated Pedicles & laminae (neural arch),
transverse processes & spinous process.
• Uncommon lesion (< 5%).
• ? In conjunction with the typical paradiscal Variant
• Radiographically - erosive lesions, paravertebral
shadows with intact disc space.
• Rarely, present as synovitis of facet joints.
25.
26. Collapse of the vertebral body
Tuberculous granulation tissue + caseous matter + necrotic
bone
Accumulate beneath the anterior longitudinal ligament.
Gravitate along the fascial planes
Present externally at some distance from the
32. • Long standing history of • History of days to months.
months to
Years
• Not present.
• Presence of active pulmonary
tuberculosis -60%
• Most common location lumbar
• Most common location thoracic spine.
spine
followed by thoraco-lumbar
region.
• 19% only. Mostly involves 1
spinal
• > 3 contiguous vertebral body segment – 2vertebrae &
involvement common- 42%. intervening
disc.
• Vertebral collapse -67% • 21% only.
33. • Bone destruction : 73% • 48%
• Posterior elements involvement • Rare
common
• Skip lesions common • Rare
•Disc is involved with less • Disc destruction is most often seen
frequency in
and severity. Disc spared in pyogenic osteomyelitis.
central
type TB.
• Paraspinal and epidural
abscesses-
60%
34. • Paraspinal and epidural • 30%
abscesses-
60%
1. Rare
1. large involving many features + abscess character.
contiguous
vertebral bodies level 2. Not seen.
2. calcification if present is
pathognomic. 3. Heterogenous enhancement.
Thick
3. Smooth rim enhancement - irregular Rim enhancement only
74% 9%
• TO SUMMARISE: atypical cases.
35. • Predilection for the lumbar spine.
• Intact vertebral architecture
despite evidence of diffuse
vertebral osteomyelitis.
• Gibbus deformity rare.
• Smaller paraspinal abscesses
• Facet joint involvement
36. • Patients with diabetes mellitus,
syringomyelia, syphilis, or
other neuropathic disorder
• Destructive changes in the
vertebralbodies large osteophytes,
extensive vertebral sclerosis.
• Loss of disk space but no hyperintensity
or enhancment
• No paraspinal soft-tissue lesion
37. A destructive bone lesion A destructive bone
associated with a poorly lesion associated with a well
defined preserved
vertebral body endplate, with disk space with sharp
or endplates suggests
without a loss of disk height, neoplastic
suggests an infection, which infiltration.
has a
better prognosis
“Good disk, bad news;
bad disk, good news"
39. • Children
• Congenital anomalies of spine
• Hemivertebra
• Block vertebra
• Defect or synostosis of neural arc
No signs and symptoms of TB, no paravertebral
shadow
/ associated anomalies
• Calves disease
40. Adolescents
• Scheurmans disease
-ischemic lesion of appophysis of several vertebra
-rounded kyphosis
-minimal local symptoms
• Schmorls disease
42. • Incidence : 10 – 30 %
• Dorsal spine most common
• Motor functions affected before / greater than sensory.
• Sense of position & vibration last to disappear.
43. • Inflammatory Edema :
Vascular stasis , Toxins.
• Extradural Mass :
Tuberculous osteitis of VB & Abscess.
• Meningeal Changes : • Dura as a rule not involved•
Extradural granulation •--- Contraction / Cicatrization •---
Peridural fibrosis •---- Recurrent Paraplegia
44. • Bony disorders :
Sequestra , Internal Gibbus
•Infarction of Spinal Cord :
Endarteritis, Periarteritis or thrombosis of tributary to ASA.
• Changes in Spinal Cord :
Thinning (Atrophy), Myelomalacia & Syrinx
45. GROUP A (EARLY ONSET GROUP B (LATE ONSET
PARAPLEGIA) a/k/a Paraplegia PARAPLEGIA) a/k/a Paraplegia
associated with active associated with healed disease :
disease :
Active phase of the disease After 2 years of onset of
within first 2 years of onset. disease.
Pathology - inflammatory Recrudescence of the
edema, granulation tissue, disease or due to mechanical
abscess, caseous material or pressure on the cord.
ischemia of cord.
Pathology can be
sequestra, debris, internal gibbus
or stenosis of the canal
46.
47.
48. • Rest in hard bed
• Chemotherapy
• X-ray & ESR once in 3 months
• MRI/ CT at 6 months interval for 2 years
• Gradual mobilization is encouraged in absence of
neural deficits with spinal braces & back extension
exercises at 3 – 9 weeks.
• Abscesses – aspirate when near surface & instil
1gm
• Streptomycin +/- INH in solution
49. • Sinus heals 6-12 weeks
• Neural complications if showing progressive
recovery on ATT b/w 3-4 weeks -- surgery
unnecessary
• Excisional surgery for posterior spinal disease
associated with abscess / sinus formation +/- neural
involvement.
• Operative debridement–if no arrest after 3-6 months
of ATT / with recurrence of disease .
• Post op spinal brace→18 months-2 years
54. No sign of neurological recovery after trial of 3-4 weeks
therapy
Neurological complications develop during conservative
treatment
Neuro deficit becoming worse on drugs & bed rest
Recurrence of neurological complication
Prevertebral cervical abscess with difficulty in deglutition &
respiration
Advanced cases- Sphincter involvement, flaccid paralysis or
59. • Smith & Robinson
Oblique / transverse incision.
Plane b/w SCM & carotid sheath laterally & T-O medially.
Longitudinal incision in ALL open a perivertebral abscess,
or the diseased vertebrae may be exposed by reflecting the
ALL
& the longus colli muscles.
• Hodgson approach via posterior triangle by retracting SCM,
Carotid sheath, T & O anteriorly & to the opposite side.
60. • Anterior transpleural transthoracic approach (Hodgson
& Stock, 1956)
• Anterolateral extrapleural approach (Griffiths, Seddon &
Roaf,
1956)
• Posterolateral approach (Martin,1970)
{Dura is exposed by hemilaminectomy first & then
extended laterally to remove the posterior ends of 2 – 4
ribs, corresponding transverse processes & the
pedicles}.
61. • Left sided
incision preferable
• Incision made along the rib which in the mid-axillary line, lies
opposite the centre of the lesion (i.e. usually 2 ribs higher than
the
centre of the vertebral lesion).
• For severe kyphosis, a rib along the incision line should be
removed.
• J-shaped parascapular incision for C7 – D8 lesions, scapula
uplift & rib resection.
• After cutting the muscles & periosteum, rib is resected
subperiosteally.
62. • Parietal pleural incision applied & lung freed from
the parieties & retracted anteriorly.
• A plane developed b/w the descending aorta & the
paravertebral abscess / diseased vertebral bodies by ligating
the intercostal vessels & branches of hemiazygos veins.
• T-shaped incision over the paravertebral abscess.
• Debridement / decompression with or without bone grafting.
63. • Griffith et al -- prone position
• Tuli --- Right lateral position
Advantage:-
1. avoid venous congestion
2 . avoid excessive bleeding
3. permits free respiration
4. Lung & mediastinal contents fall anteriorly
• Parts to remove :
Posterior part of rib (~8cm from the TP)
Transverse process (TP)
Pedicle
Part of the vertebral body
64. • • Semicircular incision
• • For severe kyphosis, additional 3-4 transverse
processes and
• ribs have to be removed.
• • Intercostal nerves serve as guide to the intervertebral
• foramina & the pedicles.
65. • Left side approach
• Semicircular incision
• Expose and remove transverse process subperiosteally.
• Preserve lumbar nerves
66. • 45 ⁰ right lateral position with bridge centred over the area
to be exposed.
• Similar incision as nephroureterectomy or sympathectomy
• Strip peritoneum off posterior abdominal wall and kidney,
preserving ureter.
• Longitudinal incision along psoas fibres for abscess
drainage
• Retract the sympathetic chain
• Double ligation of lumbar vessels.
67. • Left side preferred ( left Common iliac vessels longer &
retracted easily).
• Lazy “S” incision
• Strip & reflect the parietal peritoneum along with ureter &
spermatic vessels towards right side.
68. • Supine position
• Midline incision from umbilicus to pubis.
• Lumbo-sacral region identified distal to aortic bifurcation and
left common iliac vein.
• Longitudinal incision on parietal peritoneum over lumbo-
sacral region in midline.
• Avoid injury to sacral nerve & artery and sympathetic
ganglion.
69. • By– Albee & Hibbs
• Albee– Tibial graft inserted longitudinally in to the split
spinous processes across the diseased site.
• Hibbs– overlapping numerous small osseous flaps from
contiguous laminae , spinous processes & articular facets
Indications–
• 1. Mechanical instability of spine in otherwise healed
disease.
• 2. To stabilize the craniovertebral region (in certain cases
of T.B.)
• 3. As a part of panvertebral operation
70. • HIGH RISK PATIENTS:
- Patients < 10 years
- Dorsal lesions
- Involvement of >= 3 vertebrae
- Severe deformity in presence of active disease,
especially in children is an absolute indication for
decompression , correction and stabilization.
Staged operations-
• 1. Anteriorly at the site of disease,
• 2. Osteotomy of the posterior elements at the deformity &
• 3. Halopelvic or halofemoral tractions post-operatively.
71. • Griffiths et al (1956) :anterior transposition of cord
through
laminectomy
• Rajasekaran (2002): posterior stabilization f/b anterior
debridement and bone grafting ( titanium cages) in
active stage of disease and vice versa for
healed disease.
• Antero-lateral (Preferred approach) .
72. • Fundamentals of correction:
1. to perform an osteotomy on the concave side
of the curve and wedge it open ( secured with strong
autogenous iliac
grafts) .
2. to remove a wedge on the convex side and
close this wedge ( Harrington compression rods and
hooks)
73.
74. • • Less than 1% of all spinal tuberculosis.
• • Young patients (14 to 65 years), F: M = 2:1.
• • Infection from primary sites (paranasal sinuses,
nasopharyngeal or
• retropharyngeal lymph nodes) spreads retrograde via
lymphatic route.
• PRESENTATION:
• 2 months to 2 years to produce symptoms
• – Cervico-medullary compression,
• – Cranial nerve deficits
• – Atlanto-axial instability,
• – Abscess formation
77. CONSERVATIVE :
• – Absolute bed rest
• – Cervical traction for unstable spine
• – Prolonged external immobilization
• – ATT X 18 months
SURGERY :
• Gross bony destruction with instability
• Abscess formation
• Severe or progressive neurological deficit
• Unstable spine following conservative therapy(failed
• therapy)
• Doubtful diagnosis (esp. with neoplasm)
78. • Tuberculosis of Skeletal System SM Tuli - 4th edn
• Spine Surgery – Edward C. Benzel 2nd edn
• Campbell‟s Operative Orthopaedics – 11th edn
• Synopsis of Spine Surgery – Howard S Ann
• The Story of Orthopaedics - Mercer Rang
• Harrison‟s Principle‟s of medicine – 17th edn
• Chapman‟s Orthopaedic Surgery – 3rd edn