Tuberculosis tb disease is treated in most cases with a regimen of several drugs taken for 69 months. Spine deformity kyphosis of some degree occurs in almost every patient. In those coinfected, a high frequency of extrapulmonary disease has been observed 1, 2. Among the 35 patients with extrapulmonary tuberculosis, 14% patients had spinal tuberculosis. Spinal tuberculosis synonyms, spinal tuberculosis pronunciation, spinal tuberculosis translation, english dictionary definition of spinal tuberculosis. We describe a fatal case of a patient with spinal tb, who was. It describes and updates material the author has previously published on this subject. Spinal tb is a very dangerous type of skeletal tb as it can be. Spinal tuberculosis or potts disease is an infection of the vertebral column caused by mycobacterium tuberculosis. Tuberculosis was popularly known as consumption for a long time. Tuberculosis of spine presentation and treatment bone.
The spinal column is involved in less than 1% of all cases of tuberculosis tb. The most frequently affected level was the thoracic spine, found in 20 patients 52. 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. Spine tuberculosis is the commonest form of skeletal tuberculosis. Surgical management of spinal tuberculosis springerlink. It is caused by a bacterial microorganism, the tubercle bacillus or mycobacterium tuberculosis. 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. Pdf the spinal column is involved in less than 1% of all cases of tuberculosis tb. Early diagnosis of spinal tuberculosis sciencedirect.
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. Pott disease is tuberculosis of the spine, usually due to haematogenous spread from other sites, often the lungs. Worldwide tuberculosis is the commonest infectious disease and about 95% of cases occur in developing countries. 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. Spinal tuberculosis can paralyze if ignored pune news. It is a serious infection capable of causing severe deformity of the spine and even lower body paralysis paraplegia. Tuberculosis spine radiological spine at risk signs in the. 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. Spinal tuberculosis is usually a secondary infection from a primary site in the lung. His mr images showed destruction of bodies of l4,l5.
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. A judicious combination of conservative therapy and operative decompression when needed should. Tuberculosis of the back is known as tubercular spondylitis or spinal tuberculosis. Although tb can be treated, cured, and can be prevented if persons at risk take certain. A report from the medical research councils working party. Spine tuberculosis is a common locationof bone tuberculosis infection, often resulting in a kyphotic. 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. Tb is caused by mycobacterium tuberculosis and it spreads.
Tuberculous meningomyelitis in magnetic resonance imaging. Tuberculosis is the most common hivrelated opportunistic infection worldwide. Thoracolumbar spine in 8 patients 21%, lumbar spine in 9 patients 24% and cervical spine in. It is associated with significant morbidity and can lead to severe functional impairment. Natural history of posterior spinal tuberculosis has been described. The prevalence of spinal tuberculosis is likely to rise as the numbers of those infected with human immunodeficiency virus rises. Both pressure and ischemia combine to produce anterior scalloping 4 fig. It affects mostly at the thoracic and lumbar region owing to its blood supply but uncommonly spreads to the cervical spine. The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected. Pdf spinal tuberculosis is a destructive form of tuberculosis. General and simple presentation of tuberculosis of spine on incidence, pathology, complications, management. 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. A common name for this infection is potts disease named after the 18th century london surgeon percivall pott who first described the disease. Tuberculosis of the spine tuberculosis of the spine potts disease is tuberculoses spondylitis that usually affects thoracic portion of the spine.
He was a known case of pulmonary tuberculosis undergoing treatment. Tuberculosis spine radiological spine at risk signs in. Currently, 10 drugs are approved by the food and drug administration fda for treatment of tb. Nowadays, there is an increasing trend of spine tuberculosis in the country in view of irregular medical management, emergence of resistant strains.
Aug 08, 2019 pott disease, also known as tuberculous spondylitis, is a classic presentation of extrapulmonary tuberculosis tb. Tuberculosis of spine is also referred to as tuberculous spondylitis. Tuberculosis spine radiological spine at risk signs in the adult population. Of these, the four drugs that form the core for firstline treatment regimens are isoniazid inh. A fatal case of spinal tuberculosis mistaken for metastatic lung. Chapters on new methods and treatments and on animal tuberculosis are included. Percivall pott first described about the tuberculosis of the spine as a painful kyphotic deformity of the spine related to the. Spinal tuberculosis was discovered by pott in 1776 and is the result of. Although tuberculosis tb is an ancient disease, it remains a major global public health problem. Spinal tuberculosis definition of spinal tuberculosis by. This resurgence is related to the increasing number of patients immunocompromised by chemotherapeutic. It is followed by lumbar, upper dorsal, cervical and sacral regions in decreasing order of frequency. Cervical spinal tuberculosis cst accounts for 35 % of spinal.
Several patients can present with merged syringomyelia. 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. Diagnostic imaging of solitary tumors of the spine rsna. 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. 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. Mar 23, 2017 this is a orthopedic teaching video from orthopedic medical students on trauma or elective orthopedic surgery and relevant topics. Pdf the overall prevalence of spinal tuberculosis tb in south africa is currently 948 per 100 000.
This is a orthopedic teaching video from orthopedic medical students on trauma or elective orthopedic surgery and relevant topics. Upadhyay ss et al 1993 17year prospective study of surgical management of spinal tuberculosis in children. This bacterium typically attacks the lungs but may also attack other parts of the body such as the kidney, spine, and brain. The patho genesis of this disease are tuberculous meningitis followed by spread of spinal tuberculosis to the spinal canal. 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. 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. Dec, 2018 tb is caused by mycobacterium tuberculosis complex, which has around 60 species. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Some authors suggest combining hyperbaric oxygen ther apy with antituberculosis treatment to decrease the duration of treatment 41, but more studies are. 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. This condition is of great diagnostic importance due to its link to neurologic deficits and painful spinal deformities. Spinal tuberculosis, potts spine, magnetic resonance imaging, plain radiograph, spinal cord compression. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. When a person has tuberculosis in the lungs or throat, tuberculosis transmission can occur to other people.
In 1779, percivall pott, for whom the disease is named, presented the classic description o. It constitutes about 50 percent of all cases of bone and joint tb. The diagnosis of spinal tuberculosis was provided by isolating the agent only in 39. Tuberculosis may also be linked to certain risk factors, including alcoholism, iv drug abuse, and homelessness. Tuberculosis of spine presentation and treatment bone and spine. Introduction percival pott presented the classic description of spinal tuberculosis tb in 1779. Anterior instrumentation for cervical spine tuberculosis. The incidence of spinal tuberculosis is increasing in developed nations.
Tuberculous meningomyelitis often presents with a history of tuberculosis or a history of contact. Among them only mycobacterium tuberculosis the most common, mycobacterium bovis, mycobacterium microti, and mycobacterium africanum are known to affect humans. The main part of the book comprises very detailed and richly illustrated clinical chapters. These videos have been created by and for our medical students.
Patients with spinal tuberculosis usually present with pain. A 25yearold incarcerated man with cervical and occipitocervical junction tuberculosis presented with altered mental status and. Spinal tuberculosis is more common in children and young adults. Tuberculosis of the spine used to be a disease of early childhood in the past. The disease remains an important public health issue in developing countries, but is also returning in developed countries due to immigration. A 25yearold incarcerated man with cervical and occipitocervical junction tuberculosis presented with. This presentation summarizes present knowledge of spinal tuberculosis and its management. Tuberculosis of the spine most commonly occur in the lower thoracic region, followed by the lumbar, cervical regions, upper dorsal and sacral regions. Combining radical surgery with a standard triple or quadruple.
Meticulous neurologic examination tuberculosis of the spine. The infection can spread from two adjacent vertebrae into the adjoining intervertebral disc space. Cases of tuberculosis are caused by a bacterium called mycobacterium tuberculosis. Tuberculosis is a deadly disease affecting many people in the world. Tuberculosis spine known after sir percival pott this is the most common form of skeletal tuberculosis constituting about 50 % of all cases. Regional distribution cervical12 % cervicodorsal5 % dorsal42 % dorsolumbar12% lumbar26 % lumbosacral3 %. Oct 17, 2019 tuberculosis of the spine tuberculosis of the spine potts disease is tuberculoses spondylitis that usually affects thoracic portion of the spine.
Onehundred and thirty eight 10% patients were coinfected with tuberculosis. Combining the results of the four electronic searches and removing. Tb is caused by mycobacterium tuberculosis complex, which has around 60 species. May, 2015 answer to radiologic case study tuberculosis of the cervical spine. Infection with hiv increases the risk of reactivation of dormant tuberculosis and the risk of acquiring the primary infection. Pott disease this is a pathological condition of the spine where a bacterial infection commonly known to cause tuberculosis gets lodged in the spine. Department of spine surgery, ganga hospital, 3, mettupalayam road, coimbatore 641043, india. 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. Uncomplicated spinal tb has good response to appropriately dosed.
Tuberculosis tb of spine is part of an extrapulmonary tuberculosis manifestation and is the most common form of skeletal tuberculosis. Dtbe pdf american thoracic society centers for disease control. Tuberculosis of the spine is still the most preferred site of osteoarticular tuberculosis. Pathophysiology and treatment of spinal tuberculosis.
Though this infection most commonly occurs in the lungs, it may sometimes affect the bones of the spine. Spine tb is most commonly found in the first three decades of life but can occur in any age group. 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. Spinal tuberculosis is a destructive form of tuberculosis. Dorsal spine most commonly involved most common first 3 decades. The current consensus is to diagnose and treat spinal tb early, prevent. Case reports of two women with tuberculosis tb of the spine potts disease presenting with severe back pain and diagnosed as. If only one vertebra is affected, the disc is normal, but if two are involved, the disc, which is avascular, cannot recei. People with tuberculosis in other parts of the body, such as the kidneys or spine, usually cannot spread the bacteria to others. Thirteenth report of the medical research council working party on tuberculosis of the 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. About 90% of patients with spinal tuberculosis were african and 10% from other races.
Answer to radiologic case study tuberculosis of the cervical spine. Bone localization of tuberculosis mainly affects the thoracolumbar spine. Spinal tuberculosis, known as potts disease, accounts for half the cases of. Tuberculosis of the spine potts disease presenting as. Short course chemotherapy in the treatment of surgical tuberculosis. Tuberculosis of the spine occurs most commonly in the lower thoracic region. Update on the surgical management of potts disease sciencedirect. Spectrum of mr imaging findings in spinal 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. It causes a kind of tuberculous arthritis of the intervertebral joints. A comprehensive textbook on tuberculosis that covers all aspects of the disease. The most freque the thoracic and the thoracolumbar spine. Tuberculosis is an infection caused by a germ named mycobacterium tuberculosis. 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. New treatment strategies combine conventional surgical methods, closed. Computed tomographic scans and mag netic resonance imaging of the. The world health organization estimates that in china alone there are 1. Hong kong operation compared with debridement surgery for short and long term outcome of deformity. 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. Onestage anterior radical debridement and reconstruction with.
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