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POTT'S DISEASE

POTT'S DISEASE?

Pott's

disease or Spondylitis tuberculosis is wrong one disease oldest on human , fou

nd on mummy ancient in Egypt and Peru. Percival

Pott shows picture classic spinaltuberculosis at year 1779.

Pott's

disease or Spondylitis tuberculosis is infection tuberculosis extrapulmonary that the

one or more bone back . In

America, spondylitis tuberculosis is most manifestations ontuberculosis musculoskeletal

(40-50%
of cases ). Spondylitis tuberculosis is the most dangerous form from tuberculosis

musculoskeletal because could cause destruction bone ,deformity and paraplegia.

Condition generally involving thoracic vertebrae and lumbosacral . Thoracal Vertebra

under is regions at most involved (40-50%), with lumbarvertebrae is the

place second Most (35-45%). About 10%

of cases involves the cervical vertebrae . Management spondiltis tuberculosis could

on conservative or action operative, in Where things rehabilitation program me

dical required for maintain and fix function seoptimal may ,

also prevent occurrence complications .

THE STRUCTURE OF BACK ANATOMY Bone back composed from 33 segments namely :
7 segments bone neck ( cervical ),

12 segments breastbone (thoracic), 5 segments bone hips( lumbar ),

5 segments bone sitting

( sacred ) and 4 bones tail ( kogsigeal ). By anatomical every segment bone

back will composed from two part : 1. Section frontPart this structure prima

rily is body bone back ( corpus

vertebrae ). Part this function primarily is for buffer weight body . In betwee

n two adjacent vertebral bodiesconnected by structure called discus intervertebral

shape as discs , consistency chewy and function as silencer shock ( shock

absorber ). 2. Section back Part back fromsegment bone back this function to
:  Allow occurrence movement bone back that alone . It is possible by

because in part this there two joints .  Functionprotection , by because part

this shape as ring from very bones strong where in hole in

the middle located marrow bone back (spinal cord / spinal

cord ).  Functionstabilization . Because function bone back for human is very

important , then function stabilization this

is also important once . Function this obtained by strong joints inparts reinforc

ed rear by existence ligaments and muscles are very strong . Second structure

last this connect bone back good from segment to adjacent segments as

wellalong bone back start from cervical to kogsigeal .


Figure 1. Ventral cross section of

the column vertebral Vascularization columns spinal vertebral artery that led blood

to the vertebrae, is branch from :

 Vertebral artery and cervical arteria ascendens in the neck

 Posterior intercostal arteria in the region thorakal

 Arteria subkostalis and lumbar artery in the abdomen

 Arteria iliolumbalis and sacral arteria lateral spinal artery enters

the intervertebral foramen and branched

off be branch end and branch radicular . Some from branches thisanastomosis wi

th spinal cord arteries . Spinal vein forming widespread venous plexus along col
umns vertebral, either next in ( plexus venosi vertebral profundus ) and alsonext

door outside ( plexus venosi vertebral superficialis ) canal vertebral . Basilvertebra

l veins located in corpus vertebrae.

PATHOGENESIS Infection Mycobacterium

tuberculosis on bone always is infection secondary . Expanding germs in body d

epends on malignancy germs and endurance bodysufferers . Reaction body after st

ricken germs tuberculosis divided into five stages, namely: 1. Stage

I (implantation) this Stadium happen early , when malignancy germs morestrong fro

m power hold body . On generally happen on area thoracic or thoracolumbal s

olitary or several levels. 2. Stage II ( Destruction beginning ) Occurred 3-


6 weeksafter implantation . About discus intervertebral . 3. Stage III

( Destruction continue and Collapsed ) Happened after 8-12 weeks from stage

II. When this stadium no treated thenwill happen a great destruction and collapse

with formation ingredients chanting and pus ( cold abscess ). 4. Stage IV

( Disturbance Neurological ) Occurrence complicationsneurological , can form interfer

ence motor , sensory and autonomous . 5. Stage V

( Deformity and Consequences ) Usually occur 3-5 years after stage

I. Kiposis or gibuspermanent there is , even after therapy .

Figure 3. Spondylitis tuberculosis . A) Gibus thoracolumbar with hypertonus erector trunk

us . Patients
leaning self on extremities top ; B) 1. rarefaksi the anterior part of the

vertebra begins visible narrowing discus

intervertebralis ,

2. rarefaksi expanding , narrowing Clearly, 3. vertebral compression ventral part, the gibus

Regional spinal cord compression are normally exposed the anterior portion

of the vertebral body . Destruction progressive bone result vertebral collapse and

kyphosis . Channelsspinalis narrowed because existence abscess or network granulat

ion . This result compression spinal cord and deficit neurological .

DIAGNOSIS 1. History disease and picture clinical :


 Onset

of disease usually some month - year form weakness general , lust eat decrease

d , weight body down , sweat night day , temperature body increased a

little in the afternoon and night day .

 Pain on back is symptoms early and often found .

 Gibus .

 Cold abscess .

 Abnormality neurological happen in 50%

of cases and covers compression spinal

cord form interference motor , sensory as well autonomous corresponding with its
weight destruction bone back , kyphosis and abscesses are formed .

 Tuberculosis

of the cervical vertebrae rarely found but have condition more serious because e

xistence complications neurological weight . Condition this especially followed withpa

in and stiff . Patient with cervical vertebral disease under found with dysphagia

or stridor. Symptoms also include torticollic , hoarse and deficit neurological .

2.Examination support

 Tuberculin skin test: positive

 Rate endap blood : increased

 Microbiology ( from network bone or abscess ): resistant bacillus acid (+)


 X-ray:

- destruction corpus anterior vertebral part - increase anterior wedging - collapse

corpus vertebra

 CT scan:

- illustrates bone more details with lesions irregular lytic , and disk collapse da

mage bone - resolution contrast low illustrates network soft more well , especiall

yarea paraspinal - detect lesions early and effective for illustrates form and calcif

ication from abscess network soft

 MRI - standard for evaluate infection disk

space and most effective in show expansion disease to in network soft and deb
ris spread of tuberculosis under ligaments anteriorand posterior longitudinalis -

most effective for show neural compression

HANDLING 1. THERAPY conservative :

 Medikamentosa :- Rifampicin 10-20 mg / kgBW , maximum 600 mg

/ day - Etambutol 15 mg / kgBW , maximum 1200 mg / day - Pyridoxine 25 mg

/ kgBB - INH 5-10 mg /kgBW , maximum 300 mg

/ day Etambutol given in 3 months , while others

are given in 1 year . All drug given once in day .

 Immobilization

 Prevention complications immobilization long - turning every 2


hours for avoid ulcers dekubitus - exercise large motion joints for prevent contra

ctures - exercise Respiratoryfor strengthen muscles Respiratory and prevent occurrence

orthostatic pneumonia - exercise strengthening muscle - bladder training and bowel

training when there is interference -

mobilization gradually corresponding with development disease

 Activity program life daily corresponding development disease 2. Operation Indic

ation operation :

- existence abscess paravertebra - progressive deformity - symptoms emphasison ma

rrow bone back - interference function progressive lung - failure therapy conservat

ive in 3 months - occurs paraplegia and spasticity great that


is not could controlledContra-indication operation :

- failure Respiratory with abnormalities a dangerous heart operation By line big

action operative divided become :

a. Debridement Done pussy evaluation, b ahan kaseous and sequestra without do a

ction any on his

bones . b. Operation radical Excision do from on to to under covers whole b

one back was broken,until reach healthy area and posterior reach duramater . Ne

xt with grafting taken from kosta or tibia. On generally covers anterior radical

focal debridement and stabilization withinstrumentation .

REFERENCES 1. Hidalgo JA. Pott Disease (Tuberculous


Spondylitis). http://www.eMedicine.com 2. Thamrinsyam H, SM May Wulan , Reni

HM. Rehabilitation Medical on Spondylitis

Tuberculosis 3. Bayu S. View General Problem Bone Back . In : Bayu S et

al. , Editor.

Disturbance Bone Back . Committee The 3rd National Congress of

the Union Doctor Specialist Rehabilitation Medical Indonesia. Surabaya, 1994: 1-8 4.

Moore KL & Agur AMR.Anatomy Clinical Basic . Vivi S& Virgi S,

editor. Publisher Hippocrates . Jakarta, 1995: 191-216 5. R Sjamsuhidajat & Wim de

Jong. -Ajar Science Books Surgery . EGC.Jakarta, 1997: 20-7, 1226-30


6. Frymoyer JW. The Adult Spine: Principles and Practice . Second edition. Lippincott-

Raven Publishers. Philadelphia, 1997: 1057-147