TUBERCULOSIS OF SPINE (Pott’s disease)
TUBERCULOSIS OF THE SPINE (Pott’s disease)
- The spine is the commonest site of bone and joint tuberculosis.
- Dorso-lumbar region affected most frequently.
Types of vertebral tuberculosis:
1. Paradiscal: commonest type
- Single vertebra is affected.
- This leads to early collapse of the weakened vertebra.
- The nearby disc may be normal.
- The collapse may be a ‘wedging’ or ‘concertina’ collapse
- infection is localised to the anterior part of the vertebral body.
- the posterior complex of the vertebra i.e., the pedicle, lamina, spinous process and transverse process are affected.
- Pain (back pain)
- Cold abscess
- Deformity: increasing prominence of the spine – gibbus.
- Constitutional symptoms: Symptoms like fever, weight loss etc.
- Reduction of disc space: earliest sign
- Destruction of the vertebral body
Evidence of cold abscess:
1). Para-vertebral abscess-
- fusiform para-vertebral abscess (bird nest abscess – an abscess whose length is greater than its width (Fig-23.7a);
- globular or tense abscess – an abscess whose width is greater than the length
2). Widened mediastinum-
3). Retro-pharyngeal abscess
4). Psoas abscess
- Rarefaction: diffuse rarefaction of the vertebrae above and below the lesion.
- Unusual signs: erosion of the posterior elements of pedicle, lamina etc.
- Signs of healing
- very useful investigation in cases presenting as ‘spinal tumour syndrome’.
- Investigation of choice to evaluate the type and extent of compression of the cord.
- ESR, Mantoux test, ELISA test for detecting anti- tubercular antibodies, chest X-ray, etc.,
- Cold abscess: commonest complication of TB of the spine.
- Neurological compression: At times the patient presents as a case of spinal tumour syndrome.
- First clinical symptom being a neurological deficit.
- Tuberculosis in Pott’s disease involves Spine.
- Pott’s spine is commonest at Thoracolumbar spine.
- Tuberculosis of spine is common at Thoracolumbar.
- Most common cause of cold abscess of chest wall is Pott’s spine.
- Commonest presenting symptom of Pott’s spine is Back pain.
- The paradiscal type is M/C type of vertebral tuberculosis.
- Wedging or Concertina collapse: in central type.
- Pott’s disease: M/C cause for kyphosis & cold abscess.
- Earliest radiological sign of spine tuberculosis is reduction of intervertebral disc space.
- M/C complication of spine tuberculosis cold abscess.
- Investigation of choice- MRI.
- M/c performed surgery- Antero lateral decompression.
- TB of spine à bony ankylosis, other bones & joints a fibrous ankylosis.