Question
Which of the following is true about skeletal tuberculosis in children?
| A. |
Most common sites are hip (40%), Spine (20%), Knee (10%)
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| B. |
Most common site is upper limb
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| C. |
Dorsolumbar spine is most commonly affected
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| D. |
Progression to kyphosis deformity is least with lumbar lesions
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Show Answer
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Correct Answer » D
Explanation
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Ans. is ‘d’ i.e., Progression to kyphosis deformity is least with lumbar lesions
Tuberculosis in children
Extra-pulmonary tuberculosis accounts for 5 – 10% of total cases of tuberculosis in children. About 1/3 of children with tuberculosis have extrapulmonary tuberculosis
The most common mode of presentation in a child less than 2 years is development of a gibbusof the dorsal area. Under the age of four, backache in children should be regarded as pathological unless and until proved otherwise. MRI cannot differentiate between pyogenic or tuberculous infection.
Vertebral tuberculosis is the most common form of skeletal tuberculosis in children, accounting for 50% of all cases in reported series. Approximate distribution in the skeleton are spine (50%), hip (20%), knee (10%), ankle and foot (5%), hand and wrist (3%), elbow (2%), shoulder (1 %), bursal sheaths and other bones (8%)
The thoracic spine is most commonly affected; the radiological features include bone marrow oedema and enhancement, posterior element involvement, canal stenosis, and spinal cord or nerve root compression. Inter-vertebral disc enhancement, vertebral collapse and kyphosis deformity are particularly suggestive of tuberculosis.
Those with dorsal lesions have maximal deformity at the time of presentation, partly due to the additive effect of the normal thoracic kyphosis. However, the rib cage offers protection against additional collapse. Patients with dorsolumbar lesions have the worst prognosis as they tend to collapse more during the active phase of the disease and even more during the growth period. Those with lumbar lesions have the best prognosis with the least deformity at presentation, a lesser increase during the active phase, and also a tendency for substantial decrease during the growth period.
