1) Tuberculosis of the spine, also known as Pott's disease, most commonly affects the thoracolumbar region of the spine in children and young adults. 2) It spreads via hematogenous route from other sites like the lungs or intestines. The bacteria spreads through the venous plexus around the spine, causing granulomatous inflammation that can destroy vertebral bodies. 3) Clinical features include back pain, stiffness, deformities like gibbus or kyphosis, and cold abscesses that can track along tissues planes. Diagnosis involves imaging tests like x-rays, CT scans and MRI, while treatment consists of anti-tubercular drugs along with surgery in cases of parap

1. TUBERCULOSIS OF SPINE
(POTT’S DISEASE)

2. INTRODUCTION
The spine is the commonest
site of bone & joint tuberculosis.
The children & young adults
most commonly affected.

3. The most commonly affected
region is the dorso-lumber area.
It can involve more than one
region of spine.
The vaccinated &
nonvaccinated both groups can
have spinal tuberculosis.

4. TYPES OF VERTEBRAL
TUBERCULOSIS
1) Paradiscal – commonest type
2) Central – Body of a single
vertebra is affected.
3) Anterior – Infection is
localised to the anterior part of
vertebral body.

5. 4) Posterior (appendicial) –
Posterior complex of vertebra
i.e. pedicle, lamina, spinous
process are affected.

7. SKIP LESIONS: Some times more than one
tuberculous lesion may be present in the vertebral
column with one or more healthy vertebra in
between.

8. PATHOLOGY
T.B. of spine is always secondary.
The bacteria reaches the spine by
heamatogenous route from the
lungs, lymph nodes or intestine.
It spreads via the paravertebral
venous plexus (Batson’s plexus).

9. PATHOLOGY CONTD.
The granulomatous inflammation
spreads up and down stripping the
anterior or posterior longitudinal
ligaments and the periosteum from
the front and sides of vertebral
bodies. This results in loss of
periosteal blood supply and
destruction of many contiguous
vertebral bodies.

11. COLD ABSCESS
This is a collection of pus and
tubercular debris with bacilli from a
diseased vertebra. The abscess is
called cold because it is not
associated with signs of
inflammation.
The cold abscess penetrates the bone
and ligaments and can track along the
plane of least resistance --

12. COLD ABSCESS CONTD.
1) Anteriorly- prevertebral abscess,
Retropharyngeal abscess
2) Posteriorly- along the posterior
divisions of spinal nerves,
paravertebral abscess
3) Along 12th thoracic / Ilioinguinal
nerve –Renal abcess.

13. COLD ABSCESS CONTD.
4) Through upper opening of
psoas sheath- Psoas abscess.
5) Passing behind median
arcuate ligament –
Intraabdominal abscess.

15. CLINICAL FEATURES
1) Constitutionalsymptoms-
Fever, weight loss etc.
2)Pain presenting symptom, it
aggravates at night (night cry)
3) Stiffness- a very early symptom
of T.B. spine.

16. CLINICAL FEATURES CONTD.
4) Paravertebral swelling – a superficial
cold abscess may appear as paravertebral
swelling. It may burst through the skin
forming a discharging sinus.
5) Deformity:
Knuckle- prominence of a single spinous
process.
Gibbus – 2-3 spinous process prominence.
Kyphus ->3 spinous process prominence.

17. CLINICAL FEATURES CONTD.
6)Tuberculous paraplegia
(Pott’s paraplegia)-Early
onset and late onset
paraplegia.
7)Rarely as spinal tumour
syndrome.

18. INVESTIGATION
1) Routine blood examination –
raised ESR, Anaemia,
lymphocytosis.
2) X-ray (To find primary focus) Chest
X-ray & X-ray KUB

19. 3) X-ray of spine
Earliest sign is hazziness of the
adjacent vertebral bodies &
reduction of disc space.
Paravertebral abscess Retropharyngeal abscess

20. Destruction of the vertebral
bodies.
Evidence of cold abscess-
paravertebral bird nest type
shadow.
Widened mediastinum.
Aneurysmal sign –in anterior type.
4) CT scan- Indicates precisely the
extent of destruction of vertebra.

21. 5) MRI – It is the investigation of
choice to evaluate type and extent
of compression of the cord in case
of Pott’s paraplegia.
6) Myelography – indicated in case
presenting with spinal tumour
syndrome.
7) Biopsy – A CT guided biopsy may
be needed in doubtful cases.

22. DIFFERENTIAL DIAGNOSIS
1) Spinal pyogenic osteomyelitis.
2)Typhoid spine
3) Brucella spondylitis
4)Mycotic spondylitis
5) Syphyllitic infection of spine.

23. DIFFERENTIAL DIAGNOSIS CONTD.
6) Tumerous condition like
haemangioma, GCT,
aneurysmal bone cyst.
7) Primary spinal tumour
8) Secondary neoplastic deposits
9) Multiple myeloma
10) Spinal osteochondrosis.

24. TREATMENT
Conservative treatment
(Middle path regime)
 Rest in hard bed
 Antituberculous drugs

25. TREATMENT CONTD.
 Gradual mobilisation- after 3-
9 weeks of starting treatment
with suitable spinal braces.
 Drainage of cold abscess when
present inspite of conservative
treatment.

26. TREATMENT OF TUBERCULAR PARAPLEGIA

27. INDICATIONS OF OPERATIVE TREATMENT
1) Paraplegia appearing during usual
conservative treatment.
2) Paraplegia getting worse or
remaining stationary despite
adequate conservative treatment.
3) Rapid onset progressive paraplegia.

28. OPERATIVE PROCEDURES
1) Costo-transversectomy.
2) Anterolateral decompression
3) Radical debridement and
arthrodesis (Hongkong
operation)
4) Surgery for deformity
correction.

29. THANK YOU