Tag: TUBERCULOSIS OF SPINE (Pott’s disease)

TUBERCULOSIS OF SPINE (Pott’s disease)

TUBERCULOSIS OF SPINE (Pott’s disease)

Q. 1

Pott’s spine is commonest at which spine:

 A Thoracolumbar
 B

Sacral

 C Cervical
 D

Lumbosacral

Q. 1

Pott’s spine is commonest at which spine:

 A Thoracolumbar
 B

Sacral

 C Cervical
 D

Lumbosacral

Ans. A

Explanation:

Thoracolumbar REF: Apley 387-389, S M Tuli 3rd edition page 192

  • Most common site of skeletal tuberculosis is spine followed by hip and knee

SPINE (50%) > HIP > KNEE

  • Commonest spine involved in spine TB is Thoracolumbar/Dorsolumbar T12-L1 (Lower thoracic to be precise)

LOWER THORACIC > LUMBAR > UPPER THORACIC

  • Paraplegia due to pott’s spine most commonly involves upper thoracic vertebrae as in upper thoracic vertebrae there is more acute kyphosis, spinal canal is narrow and spinal cord is relatively large.
  • First symptom of TB spine is “Pain on movement”
  • Commonest symptom of TB spine is “Back pain”

Q. 2 Tuberculosis of spine is common at:
 A Sacral
 B Cervica
l
 C Lumbosacral
 D Thoracolumbar
Q. 2 Tuberculosis of spine is common at:
 A Sacral
 B Cervica
l
 C Lumbosacral
 D Thoracolumbar
Ans. D

Explanation:

Thoracolumbar


Q. 3

Most common cause of cold abscess of chest wall is‑

 A

Pott’s spine

 B

TB abscesses of chest wall

 C

TB of ribs

 D

Intercostal lymphadenitis

Q. 3

Most common cause of cold abscess of chest wall is‑

 A

Pott’s spine

 B

TB abscesses of chest wall

 C

TB of ribs

 D

Intercostal lymphadenitis

Ans. A

Explanation:

Ans. is ‘a’ i.e., Pott’s spine

Quiz In Between


Q. 4

True statement about chronic retropharyngeal abscess:

 A

Associated with tuberculosis of spine

 B

Causes psoas spasm

 C

Suppuration of Rouviere lymph node

 D

a and c

Q. 4

True statement about chronic retropharyngeal abscess:

 A

Associated with tuberculosis of spine

 B

Causes psoas spasm

 C

Suppuration of Rouviere lymph node

 D

a and c

Ans. D

Explanation:

 

  • Chronic retropharyngeal abscess is associated with caries of cervical spine or tuberculous infection of retropharyngeal lymph nodes secondary to tuberculosis of deep cervical nodes (i.e. suppuration of Rouviere nodes)
  • It leads to discomfort in throat, dysphagia, fluctuant swelling of postpharyngeal wall.
  • Retropharyngeal abscess does not lead to psoas spasm.

Treatment

  • Incison and drainage of abscess
  • Full course of ATT 

Q. 5

Commonest presenting symptom of Pott’s spine is:

March 2007

 A

Cold abscess

 B

Back pain

 C

Decreased spinal movements

 D

Collapse of spine

Q. 5

Commonest presenting symptom of Pott’s spine is:

March 2007

 A

Cold abscess

 B

Back pain

 C

Decreased spinal movements

 D

Collapse of spine

Ans. B

Explanation:

Ans. B: Back Pain

Tuberculosis (TB) of the spine (Pott’s disease) is the most common site of bone infection in TB. The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected.

Pott’s disease results from haematogenous spread of tuberculosis from other sites, often pulmonary. The infection then spreads from two adjacent vertebrae into the adjoining disc space.

If only one vertebra is affected, the disc is normal, but if two are involved the intervertebral disc, which is avascular, cannot receive nutrients and collapses (seen as narrowing of intervertebral space on X-rays)

The disease progresses slowly. Signs and symptoms include:

  • Localised back pain is the earliest and commonest complaint
  • Paravertebral swelling may be seen
  • Neurological signs may occur, leading to paraplegia.
  • Stiffness
  • Deformity
  • Constitutional symptoms

Spinal X-ray may not show early disease as 50% of bone mass must be lost for changes to be visible on x-ray. However, plain radiographs can show vertebral destruction and narrowed disc space.

MRI is useful to demonstrate the extent of spinal compression and can show changes at an earlier stage than plain radiographs. Bone elements visible within the swelling, or abscesses, are strongly indicative of Pott’s disease as opposed to malignancy.

CT scans and nuclear bone scans can also be used.


Q. 6

Tuberculosis in Pott’s disease involves:

September 2010

 A

Hip Joint

 B

Knee Joint

 C

Spine

 D

Wrist Joint

Q. 6

Tuberculosis in Pott’s disease involves:

September 2010

 A

Hip Joint

 B

Knee Joint

 C

Spine

 D

Wrist Joint

Ans. C

Explanation:

Ans. C: Spine

Pott’s disease is a presentation of extrapulmonary tuberculosis that affects the spine, a kind of tuberculous arthritis of the intervertebral joints.

It is named after Percivall Pott.

The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected.

Scientifically, it is called tuberculous spondylitis and it is most commonly localized in the thoracic portion of the spine.

Pott’s disease results from haematogenous spread of tuberculosis from other sites, often pulmonary. The infection then spreads from two adjacent vertebrae into the adjoining intervertebral disc space.

Quiz In Between


Q. 7

Earliest sign in X-ray in TB spine is:    

March 2011

 A

Paravertebral shadow

 B

Narrowing of disc space

 C

Gibbus

 D

Straightening of spinal curves

Q. 7

Earliest sign in X-ray in TB spine is:    

March 2011

 A

Paravertebral shadow

 B

Narrowing of disc space

 C

Gibbus

 D

Straightening of spinal curves

Ans. B

Explanation:

Ans. B: Narrowing of disc space

Reduction of the disc space is the earliest sign in the commoner, paradiscal type of tuberculosis

Skeletal TB:

  • Earliest symptom of spinal TB: Back pain
  • Earliest sign in Pott’s disease: Narrowing of disc space
  • MC vertebrae to be involved in TB spine: T9-T12
  • TB spine starts in: Vertebral body (paradiscal)
  • Spina ventosa: TB dactylitis

Q. 8

All of the following are radiological features of tuberculosis of spine except:

 A

Large paravertebral abscess

 B

Marked osteoblastic response

 C

Marked collapse of vertebra

 D

Deceased joint space

Q. 8

All of the following are radiological features of tuberculosis of spine except:

 A

Large paravertebral abscess

 B

Marked osteoblastic response

 C

Marked collapse of vertebra

 D

Deceased joint space

Ans. B

Explanation:

Ans. Marked osteoblastic response


Q. 9

Note a feature of TB spine‑

 A

Back pain earliest symptom

 B

Stiffness of back

 C

Exagrated lumbar lordosis

 D

All

Q. 9

Note a feature of TB spine‑

 A

Back pain earliest symptom

 B

Stiffness of back

 C

Exagrated lumbar lordosis

 D

All

Ans. C

Explanation:

Ans. is `c’ i.e., Exagrated lumbar lordosis

Clinical features of TB of spine

  • The disease is commonest in young adults.
  • The presenting complains are : –
  1. Back pain : Commonest and earliest symptom. Initially pain occurs on sudden movement of spine.
  2. Stiffness of back : Is also an early symptom and occur along with pain.
  3. Visible deformity : Gibbus or Kyphosis
  4. Localized swelling : Due to cold abscess
  5. Paraplagia : In neglected cases
  6. Constitutional symptoms : Evening fever, loss of appetite, night sweat, loss of weight.
  • On examination, following findings may be seen : –
  1. Decreased range of motion.
  2. Local tenderness : Over the spinous process of affected vertebra.
  3. Deformity : –
  • Cervical spine : – Straight neck with loss of cervical lordosis.
  • Thoracic : – Gibbus/kyphosis
  • Lumbar : – Loss of lumbar lordosis
  • Para-vertebral swelling : – Cold abscess

Quiz In Between



TUBERCULOSIS OF SPINE (Pott’s disease)

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.

Exam Important

  • 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.
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