Multidrugresistant tuberculosis of the spineis it the begi. Buckling collapse of the spine in childhood spinal tuberculosis. It begins with a primary focus in the lungs and then spreads through the blood into the vertebrae. Tuberculosis causes three million deaths each year, and 90 million new cases have been diagnosed in the last ten years. Compared to other diseases, early or atypical spinal tuberculosis. Spine might be involved in upto 50% of these cases. Tuberculosis spine radiological spine at risk signs in the. For the diagnosis of spinal tuberculosis magnetic resonance imaging is more. Vertebral tuberculosis most frequently involves the lower thoracic and upper lumbar spines.
A judicious combination of conservative therapy and operative decompression when needed should. Spine deformity kyphosis of some degree occurs in almost every patient. 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. The mortality rate in tuberculosis of the spine is high and the patient carries a high potentiality for disability and crippling. She was due to write her senior secondary school examination in mayjune 2020 and her basketball potentials suggest she could even be on her way to the united states afterwards, but what looks like a bright future has been truncated. Pdf tuberculosis of the spine and spinal cord alvaro. Misdiagnosed and mismanaged atypical spinal tuberculosis. Dec, 2018 a controlled trial of sixmonth and ninemonth regimens of chemotherapy in patients undergoing radical surgery for tuberculosis of the spine in hong kong. Pott disease, also known as tuberculous spondylitis, is a classic presentation of extrapulmonary tuberculosis tb. Though uncommon in developed countries, spinal tuberculosis must. The average prevalence of all forms of tuberculosis in india is estimated to be 5 per thousand.
It can spread to other parts of your body, like your brain and spine. We present two interesting cases of spinal tuberculosis. A preliminary report of three cases from the service of the orthopaedic hospital. Though this infection most commonly occurs in the lungs, it may sometimes affect the bones of the spine. It is always the consequence of haematogenous spread from a primary visceral focus pulmonary or urinary tract and it is the vertebral body that is involved, because the disc is avascular. Tuberculous spondylitis, also known as pott disease, refers to vertebral body osteomyelitis and intervertebral diskitis from tuberculosis tb. Widely seen as one of the rising prospects in the nigerian basketball scene, onu. Challenges in the diagnosis and management of spinal. The current consensus is to diagnose and treat spinal tb early, prevent complications. Diagnosis of spinal tuberculosis tb in the early inflammatory stage is essential to prevent the development of spinal deformity and neurological deficit. Spinal tuberculosis is more common in children and young. Introduction skeletal tuberculosis is common in india vertebral tuberculosis is the commonest form of skeletal tuberculosis 50% dorsal spine most commonly involved mostly seen in first 3 decades.
If the tuberculosis bacteria spread to the adjacent vertebrae, infection can occur in the bearing between the two vertebrae, called the intervertebral disc. A positive result indicates that a person has been infected with the tuberculosis bacteria at some point in his or her life. Although the first documented spinal tuberculosis tb cases date back to 5,000yearold egyptian mummies, the first modern case of spinal tb was described in 1779 by percival pott. The most common form of the disease is tuberculosis of the lungs pulmonary consumption, or phthisis, but the intestines, bones and joints, the skin, and the genitourinary, lymphatic, and nervous systems may also be affected. Spinal involvement occurs in less than 1% of patients with tb 2, 3 but the increasing frequency of tb in both developed and developing countries has continued to make spinal tb a health problem 2. Tuberculosis of the spine potts disease presenting as. Tuberculosis of the central nervous system postgraduate. Tuberculosis or tb, as its commonly called is a contagious infection that usually attacks your lungs. Neurological complications and progressive deformity are the dreaded complications of tuberculosis of spine. Case reports of two women with tuberculosis tb of the spine potts disease presenting with severe back pain and diagnosed as. This method will in the following be referred to as ortho dox treatment. It constitutes about 50 percent of all cases of bone and joint tb. Tuberculosis of the spine tuberculosis of the spine potts disease is tuberculoses spondylitis that usually affects thoracic portion of the spine.
The infection can spread from two adjacent vertebrae into the adjoining intervertebral disc space. Although tb can be treated, cured, and can be prevented if persons at risk take certain. The disease in few cases is resistant to the primary antikochs medications and the number of cases detected is on the rise. Tb disease is suspected clinically when a person presents with the symptoms mentioned above usually together with abnormal findings on a chest xray. Pdf multidrugresistant tuberculosis of the spineis it. Progression of the disease, latent and active infections. Spine tb is most commonly found in the first three decades of life but can occur in any age group.
Transmission occurs when a person inhales droplet nuclei containing. In the developing countries, the disease commonly afflicts children and young adults and tends to be more aggressive in extent and abscess formation. Dalagang dinapuan ng potts disease o tuberculosis of the spine. The diagnosis tends to be delayed because of a nonspecific initial early manifestations andor low degree of suspicion. Tuberculosis of spine presentation and treatment bone and spine. Tuberculosis of the spine, leading, if untreated, to destruction of the vertebral bones, curvature of the spine, and paraplegia.
Herpes zoster and tuberculosis of the spine jama jama network. In spinal tuberculosis mri can clearly demonstrate combinations of anterior and posterior lesions as well as pedicular involvement. 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. Archaeological evidence suggests that this disease has been a problem in human populations for thousands of years. Preliminary study of tuberculosis of the spine annals of.
Aristotle is usually credited as being the first to recognize the contagious nature of the disease. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Tuberculosis is an infection caused by a germ named mycobacterium tuberculosis. Tuberculous spondylitis radiology reference article. Tuberculosis of the spine is the most common extrapulmonary form of tuberculosis in the asian subcontinent. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. The world health organization estimates that in china alone there are 1. View tuberculosis of spine ppts online, safely and virus free. Pdf the dismal outcome of tuberculosis of the spine in the preantibiotic era has improved significantly because of the use of potent. A sample size of 61 patients statistically significant and representative deemed of the prevalence of tb spine in the population older than 15 years, ages ranging from 16 to 72 years. Arthrodesis has also been performed for many years in scoliosis to stabilize a section of the spinal column after the. Spectrum of mr imaging findings in spinal tuberculosis. About 90% of patients with spinal tuberculosis were african and 10% from other races. The technetium 99 m bone scan was negative in 35% of an series of patients with potts spine.
It is caused by a bacterial microorganism, the tubercle bacillus or mycobacterium tuberculosis. Demographic, epidemiological and clinical features, imaging findings, treatment methods, and prognosis were summarized and analyzed. Chapter 2 transmission and pathogenesis of tuberculosis. Extrapulmonary tuberculosis tb is uncommon but not rare.
It is associated with significant morbidity and can lead to severe functional impairment. Tuberculosis of the spine used to be a disease of early childhood in the past. Despite the recent belief that tuberculosis of the spine is controlled, some issues of diagnosis and management have been neglected. Tuberculosis of spinecontemporary thoughts on current issues. 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.
Tuberculosis spine by dr john ebnezar vice president of the indian orthopedic association mbbs, dortho, dnb ortho, mnams ortho, dac, dmt, diploma in sports medicineaustralia, inor fellow uk, phd yoga chief orthopedic and spine surgeon, expert in holistic orthopedics parimala health care services an iso 9001. General and simple presentation of tuberculosis of spine on incidence, pathology, complications, management. Skeletal tuberculosis is found in 1 to 3 % of these cases. Tuberculosis tb is a disease caused by germs that are spread from person to person through. Tuberculosis of spine is also referred to as tuberculous spondylitis. The disease is named after percivall pott 17141788, a british surgeon. Tuberculosis of the spine occurs most commonly in the lower thoracic region. Spinal tuberculosis, the most common form of skeletal involvement, is increasing in prevalence because of the resurgence of tuberculosis during the past decade in patients with aids, the spread of tuberculosis among the homeless, and the expanding immigrant population. The delay in diagnosis average 3months the long recovery period average 12months the great cost of treating such infections. Multidrug resistant form of tuberculosis of the spine is ill reported in the literature. 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. First is a classic form of pott disease called as spondylodiscitis and other is called spondylitis without disc involvement. Spinal tuberculosis definition of spinal tuberculosis by.
Worldwide tuberculosis is the commonest infectious disease and about 95% of cases occur in developing countries. Skeletal tuberculosis is common in india vertebral tuberculosis is the commonest form of skeletal tuberculosis 50% dorsal spine most commonly involved mostly seen in first 3 decades. The wiltse paraspinal approach to the lumbar spine revisited. Tenth report of the medical research council working party on tuberculosis of the spine. Mention of similar instances in the literature is indeed scanty. Spinal tuberculosis is a rare form of tuberculosis where the mycobacterium tuberculosis bacteria colonize the spine, leading to damage of the spinal discs and subsequent deformity. This brochure was developed for clinicians to use with patients while discussing the 12dose regimen for the treatment of latent tb infection. Nonosseous spinal cord tuberculosis can occur in the form of tuberculomas.
Spine tuberculosis is the commonest form of skeletal tuberculosis. 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. Pdf spinal tuberculosis and cold abscess without known. Tb usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. Clinical characteristics of 78 inpatients with spinal. Department of health, education, and welfare, and the national science foundation, 1975 spine 163 pages. Discovery of the specific infectious agent, the tubercle bacillus mycobacterium tuberculosis, did not occur for several millennia until it was isolated by robert koch in 1882 4.
The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected it causes a kind of tuberculous arthritis of the intervertebral joints. However, if the vertebral body of the spine is free from intervertebral. It is a well established fact that an arthrodesis results in healing and fusion of the vertebral bodies in most cases of spinal tuberculosis. 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. We describe a series of 47 patients, divided into four groups, based on the surgical protocol. The brochure contains information on latent tb infection. Tuberculosis, spinal definition of tuberculosis, spinal by. Tuberculosis was popularly known as consumption for a long time. Surgical procedures for abscess evacuation and for the treatment of paraplegia were carried out in some cases, but spine fusion was not performed. Bone and joint involvement constitute about 10% of extrapulmonary tb cases, with the spine being the most frequently affected site.
Tuberculosis can affect several tissues outside the lungs including the spine, a kind of tuberculous arthritis of the intervertebral joints. Spinal tb patients typically present with back pain but other constitutional or pulmonary symptoms may be absent, rendering the diagnosis difficult. Tuberculosis tb is a disease that usually affects the lungs. Pott disease, or potts disease, is a form of tuberculosis that occurs outside the lungs whereby disease is seen in the vertebrae. This case explores challenges in the diagnosis of spinal. This condition is of great diagnostic importance due to its link to neurologic deficits and painful spinal deformities. Sixtyfour adults with tuberculosis of the spine were treated principally with prolonged courses of antituberculosis drugs, bed rest, and braces. We propose a classification system, using information provided by mri, to help to plan the appropriate surgical treatment for patients with thoracic spinal tuberculosis. An infectious disease of humans and animals caused by the tubercle bacillus and characterized by the formation of tubercles on the lungs and. Patients with spinal tuberculosis usually present with pain. Among the 35 patients with extrapulmonary tuberculosis, 14% patients had spinal tuberculosis. Pott disease is tuberculosis of the spine, usually due to haematogenous spread from other sites, often the lungs.
Enter your email address to receive your free pdf download. Patients treated conservatively show an increase in. Ludwig ombregt md, in a system of orthopaedic medicine third edition, 20. In those coinfected, a high frequency of extrapulmonary disease has been observed 1, 2. By dr shahid latheefdepartment of orthopaedicsyenepoya medical collegemangalore 2. The part of the spine that is most often attacked by tb spine is the spine in the lower thoracic area and upper spine. Spinal tuberculosis is a destructive form of tuberculosis. The spine is the most frequent location of musculoskeletal tuberculosis, and commonly related symptoms are back pain and lower limb weaknessparaplegia. Spinal tuberculosis stb is an extrapulmonary form of tuberculosis tb caused by mycobacterium tuberculosis mtb, which accounts for around 2% of all tb cases and can lead to spine degeneration. Spinal tuberculosis article about spinal tuberculosis by. Spinal tuberculosis synonyms, spinal tuberculosis pronunciation, spinal tuberculosis translation, english dictionary definition of spinal tuberculosis. Percivall pott first described about the tuberculosis of the spine as a painful kyphotic deformity of the spine related to the. It is followed by lumbar, upper dorsal, cervical and sacral regions in decreasing order of frequency.
Tuberculosis of spine standard treatment guidelines. 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. A little more than a decade ago a form of treatment. Neurological deficit and deformity are the worst complications of spinal tuberculosis. Tuberculosis of spine presentation and treatment bone.
The observation of a patient with typical herpes zoster who, sixteen months later, proved to have tuberculosis of the spine involving the same segments implicated in the zoster stimulated my interest in this subject. Spinal tuberculosis or potts disease is an infection of the vertebral column caused by mycobacterium tuberculosis. Tuberculous spondylitis an overview sciencedirect topics. Aug 08, 2019 pott disease, also known as tuberculous spondylitis, is a classic presentation of extrapulmonary tuberculosis tb. Oct 17, 2019 tuberculosis of the spine tuberculosis of the spine potts disease is tuberculoses spondylitis that usually affects thoracic portion of the spine. Tuberculosis, although a disease of antiquity, is still all too prevalent in many areas of the world. Despite the belief that spinal tuberculosis is controlled, some issues of diagnosis and. Tb sometimes affects other parts of the body, such as the brain, the kidneys, or the spine. Tuberculosis, spinal synonyms, tuberculosis, spinal pronunciation, tuberculosis, spinal translation, english dictionary definition of tuberculosis, spinal. Ankit madharia junior resident lata mangeshkar hospital, nagpur 2. Practically all of the many methods of treatment depend on recumbency or support by aid of some sort of apparatus to. Multidrugresistant tuberculosis of the spine is it the beginning of the end.