The incidence of spinal tuberculosis is increasing in developed nations. Pott disease is tuberculosis of the spine, usually due to haematogenous spread from other sites, often the lungs. Tuberculosis tb of spine is part of an extrapulmonary tuberculosis manifestation and is the most common form of skeletal tuberculosis. Pathophysiology and treatment of spinal tuberculosis. A fatal case of spinal tuberculosis mistaken for metastatic lung.
Patients with spinal tuberculosis usually present with pain. Both pressure and ischemia combine to produce anterior scalloping 4 fig. Spinal tuberculosis can paralyze if ignored pune news. Spinal tuberculosis is a destructive form of tuberculosis. Though this infection most commonly occurs in the lungs, it may sometimes affect the bones of the spine. Tuberculosis is an infection caused by a germ named mycobacterium tuberculosis. If only one vertebra is affected, the disc is normal, but if two are involved, the disc, which is avascular, cannot recei. The world health organization estimates that in china alone there are 1. A judicious combination of conservative therapy and operative decompression when needed should. These videos have been created by and for our medical students. Cases of tuberculosis are caused by a bacterium called mycobacterium tuberculosis.
It accounts for approximately half of all cases of musculoskeletal tuberculosis. Percivall pott first described about the tuberculosis of the spine as a painful kyphotic deformity of the spine related to the. Surgical management of spinal tuberculosis springerlink. About 90% of patients with spinal tuberculosis were african and 10% from other races. Thirteenth report of the medical research council working party on tuberculosis of the spine. Chapters on new methods and treatments and on animal tuberculosis are included. The most dreaded neurological complications in tb spine occur in active stage of disease by mechanical compression, instability and inflammation changes, while in healed disease, these occur due to intrinsic changes in spinal cord secondary to internal salient in long standing kyphotic deformity. Computed tomographic scans and mag netic resonance imaging of the. Pdf the overall prevalence of spinal tuberculosis tb in south africa is currently 948 per 100 000.
The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected. Tuberculosis was popularly known as consumption for a long time. Onehundred and thirty eight 10% patients were coinfected with tuberculosis. Among the 35 patients with extrapulmonary tuberculosis, 14% patients had spinal tuberculosis. Natural history of posterior spinal tuberculosis has been described. In those coinfected, a high frequency of extrapulmonary disease has been observed 1, 2. A case report rafik elafram, rim boussetta, ismail jerbi, sami bouchoucha, walid saied and mohamed nabil nessib department of pediatric orthopedic, children hospital, tunis 1006, tunisia abstract. Short course chemotherapy in the treatment of surgical tuberculosis. Tuberculosis spine radiological spine at risk signs in. Combining the results of the four electronic searches and removing. The main part of the book comprises very detailed and richly illustrated clinical chapters.
Spinal tuberculosis was discovered by pott in 1776 and is the result of. Bones and joints tuberculosis haider abdullateef mousa mb chb, msc tuberculosis appears to be increasing throughout the world after years of continuous decline, despite the introduction of effective chemotherapy. Although tuberculosis tb is an ancient disease, it remains a major global public health problem. Tuberculosis of the spine tuberculosis of the spine potts disease is tuberculoses spondylitis that usually affects thoracic portion of the spine. An analysis of surgical experience with 61 cases premanand s ramani 1, alok sharma 2, sunil jituri 1, dattatraya p muzumdar 1 1 departments of neuro and spinal surgery, lilavati hospital and research centre, bandra west, mumbai, india 2 lokmanya tilak municipal college and hospital, sion, mumbai, india. The existence of tuberculosis tb in ancient times is evident from the fact that it was observed in mummies from egypt and peru 9000 bc and has also been described as yakshama in the oldest indian medical treatises of charaka samhita and sushruta samhita, dating back to and 600 bc, respectively. The existence of tuberculosis tb in ancient times is evident from the fact that it was observed in mummies from egypt and peru 9000 bc and has also been described as yakshama in. Dorsal spine most commonly involved most common first 3 decades. Spinal tb is a very dangerous type of skeletal tb as it can be. Case reports of two women with tuberculosis tb of the spine potts disease presenting with severe back pain and diagnosed as. Tuberculosis spine radiological spine at risk signs in the adult population. Upadhyay ss et al 1993 17year prospective study of surgical management of spinal tuberculosis in children. The diagnosis of spinal tuberculosis was provided by isolating the agent only in 39.
Early diagnosis of spinal tuberculosis sciencedirect. Tuberculosis is the most common hivrelated opportunistic infection worldwide. In 1779, percivall pott, for whom the disease is named, presented the classic description o. New treatment strategies combine conventional surgical methods, closed. Tuberculosis of the spine most commonly occur in the lower thoracic region, followed by the lumbar, cervical regions, upper dorsal and sacral regions.
This is a orthopedic teaching video from orthopedic medical students on trauma or elective orthopedic surgery and relevant topics. The most frequently affected level was the thoracic spine, found in 20 patients 52. Tuberculous meningomyelitis often presents with a history of tuberculosis or a history of contact. Bone localization of tuberculosis mainly affects the thoracolumbar spine. A report from the medical research councils working party. Mar 23, 2017 this is a orthopedic teaching video from orthopedic medical students on trauma or elective orthopedic surgery and relevant topics. Tuberculosis definition tuberculosis tb is a potentially fatal contagious disease that can affect almost any part of the body but is mainly an infection of the lungs. It is caused by a bacterial microorganism, the tubercle bacillus or mycobacterium 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. Tuberculosis may also be linked to certain risk factors, including alcoholism, iv drug abuse, and homelessness.
Tb is caused by mycobacterium tuberculosis and it spreads. Tuberculosis of spine is also referred to as tuberculous spondylitis. Spinal tuberculosis is usually a secondary infection from a primary site in the lung. Tuberculosis of the spine potts disease presenting as. Meticulous neurologic examination tuberculosis of the spine. Pott disease this is a pathological condition of the spine where a bacterial infection commonly known to cause tuberculosis gets lodged in the spine.
In the past, this condition used to be a disease of the early childhood, but with improved public health measure, the age incidence has changed and now this occurs most frequently in adults. Dec, 2018 tb is caused by mycobacterium tuberculosis complex, which has around 60 species. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Update on the surgical management of potts disease sciencedirect. Some authors suggest combining hyperbaric oxygen ther apy with antituberculosis treatment to decrease the duration of treatment 41, but more studies are. Spine tuberculosis is a common locationof bone tuberculosis infection, often resulting in a kyphotic.
He was a known case of pulmonary tuberculosis undergoing treatment. Spine tuberculosis is the commonest form of skeletal tuberculosis. It affects mostly at the thoracic and lumbar region owing to its blood supply but uncommonly spreads to the cervical spine. When a person has tuberculosis in the lungs or throat, tuberculosis transmission can occur to other people. Uncomplicated spinal tb has good response to appropriately dosed. Introduction percival pott presented the classic description of spinal tuberculosis tb in 1779. Tuberculosis of spine presentation and treatment bone and spine. Spectrum of mr imaging findings in spinal tuberculosis. How do i present a case of tb spinewith neurological deficit how to examine a spine case how to diagnose tb spine what are the other possible diagnosis how to differentiate from them clinically how they are investigated in your hospital possible options in management how is it managed in your hospital common. The infection can spread from two adjacent vertebrae into the adjoining intervertebral disc space. Thoracolumbar spine in 8 patients 21%, lumbar spine in 9 patients 24% and cervical spine in.
Onestage anterior radical debridement and reconstruction with. The most freque the thoracic and the thoracolumbar spine. Tuberculosis of the spine is a challenging disease to treat because of the prolonged time of conservative treatment and the technical difficulties of surgical intervention. Answer to radiologic case study tuberculosis of the cervical spine. Cervical spinal tuberculosis cst accounts for 35 % of spinal. Regional distribution cervical12 % cervicodorsal5 % dorsal42 % dorsolumbar12% lumbar26 % lumbosacral3 %.
The tuberculosis of the spine also called as potts disease is a pathological condition of the spine where a bacterial infection called tuberculosis gets lodged in the spinal vertebrae. It causes a kind of tuberculous arthritis of the intervertebral joints. How do i present a case of tb spinewith neurological deficit how to examine a spine case how to diagnose tb spine what are the other possible diagnosis how to differentiate from them clinically how they are investigated in your hospital possible options in management how is it managed in your hospital. Tuberculosis spine known after sir percival pott this is the most common form of skeletal tuberculosis constituting about 50 % of all cases. Spinal tuberculosis or potts disease is an infection of the vertebral column caused by mycobacterium tuberculosis. Hong kong operation compared with debridement surgery for short and long term outcome of deformity. Jun 17, 2019 pott disease this is a pathological condition of the spine where a bacterial infection commonly known to cause tuberculosis gets lodged in the spine. People with tuberculosis in other parts of the body, such as the kidneys or spine, usually cannot spread the bacteria to others. Anterior instrumentation for cervical spine tuberculosis.
May, 2015 answer to radiologic case study tuberculosis of the cervical spine. Spine tb is most commonly found in the first three decades of life but can occur in any age group. Tb of the spine typically occurs following haematogenous spread of mycobacterium tuberculosis from a primary infection site and is characterised by gradual destruction of one or more spinal. Infection with hiv increases the risk of reactivation of dormant tuberculosis and the risk of acquiring the primary infection. Spinal tuberculosis synonyms, spinal tuberculosis pronunciation, spinal tuberculosis translation, english dictionary definition of spinal tuberculosis. The current consensus is to diagnose and treat spinal tb early, prevent. The spinal column is involved in less than 1% of all cases of tuberculosis tb. Combining radical surgery with a standard triple or quadruple. Although tb can be treated, cured, and can be prevented if persons at risk take certain. Tuberculosis is a deadly disease affecting many people in the world. Pdf spinal tuberculosis is a destructive form of tuberculosis.
Dtbe pdf american thoracic society centers for disease control. Tuberculosis of the spine used to be a disease of early childhood in the past. Tuberculosis of the back is known as tubercular spondylitis or spinal tuberculosis. The disease remains an important public health issue in developing countries, but is also returning in developed countries due to immigration. Worldwide tuberculosis is the commonest infectious disease and about 95% of cases occur in developing countries. Tuberculosis of the spine occurs most commonly in the lower thoracic region. Tuberculous meningomyelitis in magnetic resonance imaging.
Tuberculosis tb disease is treated in most cases with a regimen of several drugs taken for 69 months. The patho genesis of this disease are tuberculous meningitis followed by spread of spinal tuberculosis to the spinal canal. Spine deformity kyphosis of some degree occurs in almost every patient. It is a serious infection capable of causing severe deformity of the spine and even lower body paralysis paraplegia. Currently, 10 drugs are approved by the food and drug administration fda for treatment of tb. Medical research council working party on tuberculosis of the spine a 15year assessment of controlled trials of the management of tuberculosis of the spine in korea and hong kong. His mr images showed destruction of bodies of l4,l5. Pott disease, also known as tuberculous spondylitis, is one of the oldest demonstrated diseases of humankind, having been documented in spinal remains from the iron age in europe and in ancient mummies from egypt and the pacific coast of south america. It is followed by lumbar, upper dorsal, cervical and sacral regions in decreasing order of frequency. Tuberculosis, caused by mycobacterium tuberculosis, remains a major public health hazard, especially in developing countries in which poverty, malnutrition, and the presence of drugresistant strains have combined to aid the spread of the disease. Tuberculosis of spine presentation and treatment bone. A common name for this infection is potts disease named after the 18th century london surgeon percivall pott who first described the disease. Spinal tuberculosis, known as potts disease, accounts for half the cases of.
Oct 17, 2019 tuberculosis of the spine tuberculosis of the spine potts disease is tuberculoses spondylitis that usually affects thoracic portion of the spine. A 25yearold incarcerated man with cervical and occipitocervical junction tuberculosis presented with altered mental status and. Diagnostic imaging of solitary tumors of the spine rsna. The prevalence of spinal tuberculosis is likely to rise as the numbers of those infected with human immunodeficiency virus rises. General and simple presentation of tuberculosis of spine on incidence, pathology, complications, management. Tuberculosis of the spine also known as kochs spine and tuberculous vertebral osteomyelitis is the commonest form of skeletal tuberculosis and accounts for 88% of chronic vertebral infections. Spinal tb is a very dangerous type of skeletal tb as it can be associated with neurologic deficit due to compression of adjacent neural structures and significant spinal deformity.
Spinal tuberculosis, potts spine, magnetic resonance imaging, plain radiograph, spinal cord compression. Among them only mycobacterium tuberculosis the most common, mycobacterium bovis, mycobacterium microti, and mycobacterium africanum are known to affect humans. This bacterium typically attacks the lungs but may also attack other parts of the body such as the kidney, spine, and brain. It describes and updates material the author has previously published on this subject. Spinal tuberculosis is more common in children and young adults. We describe a fatal case of a patient with spinal tb, who was. This condition is of great diagnostic importance due to its link to neurologic deficits and painful spinal deformities.
Of these, the four drugs that form the core for firstline treatment regimens are isoniazid inh. Nowadays, there is an increasing trend of spine tuberculosis in the country in view of irregular medical management, emergence of resistant strains. Tb is caused by mycobacterium tuberculosis complex, which has around 60 species. A 25yearold incarcerated man with cervical and occipitocervical junction tuberculosis presented with. This resurgence is related to the increasing number of patients immunocompromised by chemotherapeutic. This presentation summarizes present knowledge of spinal tuberculosis and its management. Pdf the spinal column is involved in less than 1% of all cases of tuberculosis tb. Several patients can present with merged syringomyelia. It is associated with significant morbidity and can lead to severe functional impairment. Department of spine surgery, ganga hospital, 3, mettupalayam road, coimbatore 641043, india. Spinal tuberculosis definition of spinal tuberculosis by. Tuberculosis of the spine is still the most preferred site of osteoarticular tuberculosis. A comprehensive textbook on tuberculosis that covers all aspects of the disease.
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