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

2. Central:

• 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 

 3. Anterior:

• infection is localised to the anterior part of the vertebral body.

 4. Posterior:

• the posterior complex of the vertebra i.e., the pedicle, lamina, spinous process and transverse process are affected.

CLINICAL FEATURES

• Pain (back pain)
• Stiffness
• Cold abscess
• Paraplegia
• Deformity: increasing prominence of the spine – gibbus.
• Constitutional symptoms: Symptoms like fever, weight loss etc.

RADIOLOGICAL INVESTIGATIONS

X-ray examination:

• Reduction of disc space: earliest sign  

• Destruction of the vertebral body 

Evidence of cold abscess:

1). Para-vertebral abscess-

1. fusiform para-vertebral abscess (bird nest abscess – an abscess whose length is greater than its width (Fig-23.7a);
2. 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

CT scan:

• very useful investigation in cases presenting as ‘spinal tumour syndrome’.

MRI:

• Investigation of choice to evaluate the type and extent of compression of the cord.

Other investigations:

• ESR, Mantoux test, ELISA test for detecting anti- tubercular antibodies, chest X-ray, etc.,

COMPLICATIONS

1. Cold abscess:  commonest complication of TB of the spine.
2. Neurological compression: At times the patient presents as a case of spinal tumour syndrome.

• First clinical symptom being a neurological deficit.