TB SPINE

BY MR. ODONGO JAMES MBChB(Mak),M.Med(Surgery)(Mak).

Specialist Surgeon.
Outline
. Definition
. Anatomy
. Etiology
.epidemiology
.pathogenesis
. Clinical presentation
.diagnosis
. treatment
definition
TB spine or pott’s disease is extra pulmonary TB that affects the spine .
Pott percivical : described TB spinal column in 1779
“ destruction of disc space and adjacent vertebral bodies , collapse of spinal elements and
progressive spinal deformity”

Robert KOCH: discovered Mycobacterium tuberculosis in 1882

Vertebral TB is the commonest form of skeletal TB.( greater than 50%).
anatomy
Etiology / predisposing factors.
. Causative organism is mycobacterium tuberculosis.
. The predisposing factors
-malnutrition
- poor sanitation
-over crowding
-close contact with TB patients
- multiple pregnanacy
- immunodeficiency state
epidemiology

. TB is one of the leading causes of deaths world wide from an infectious disease agent.
. 8 million people get TB every year of whom 95% live in developing countries.
. An estimated 2million people have active Spinal TB world wide .
. In Uganda spinal TB is on the rise because of HIV co - infection
pathogenesis
. bone and and joint TB develop 2-3yrs after the primary focus
. Bacilli from primary focus through blood stream reach disc space
. Once infected soft nucleus centre and fibrous annular wall weakens , decays and collapses.
. This causes the disc space to close squeezing down on nerve roots and causing pain.
. The infection spreads to vertebral bodies above and below the disc
. The bone weakened by the infection collapses under the weight of the human body.
Contd…
. The deformed spinal column compresses the spinal cord producing functional impairment
. Over time the deformed vertebrae heal and fuse, this may further compress nerve roots
causing pain and neurological defects.
Regional SPINE TB DISTRIBUTION
. Cervical -12%
. Cervicodorsal -5%
. Thoracodorsal- 42%
. Dorsolumbar-12%
. Lumbar-26%
. Lumbosacral-3%
Types of vertebral lesions

1. paradiscal-arterial spread
2. central- venous spread
3. anterior- subperiosteal spread
4. appendicular
5. articular
Clinical presentation
. Age . Common in the first 3 decades
. Sex . Male is equal to female
Contd..
Active stage
. B symptoms- profuse night sweats
- loss of weight
- loss of appetite
- evening fevers
- general body weakness/malaise
Specific symptoms /signs

. Night cries/ pain

, stiffness
. Deformity
. Enlarged lymph nodes
. Abscesses
. Neurologic deficits
diagnosis
1. investigations
-CBC( reduced HB %, lymphocytosis)
- ESR . Raised in active disease , normalizes with healing.
- mantoux test . Erythema of more than 20mm at 72hrs – positive
negative test in general rules out the disease
. Biopsy: in case of doubt .
. ZN smear
. IgG , IgM serological tests.
Contd…
2. imaging
-xray ( kyphosis, scoliosis, reduced disc space, destruction of vertebral bodies).
- CT scan.
- MRI.
treatment
. Supportive treatment( back care , braces, rest ,multivitamins, hematinics , analgesia.
. Anti TB DRUGS. ( Isoniazide 5mg per kg, rifampicin 10-15mg/kg, streptomycin 20mg/kg,
pyrazinamide 20-25mg/kg), ethambutol 25mg/kg
other can be amikacin , kanamycin.
. Surgical approach ; drain the abscess , decompression, fusion, debridement, laminectomy.
. Follow up
Treatment monitoring
. Do radiography and ESR every 3-6 months interval
. MRI at 6 months interval for 2yrs.
. Gradual mobilization with spinal braces,
. Patient evaluated at 3 months interval up to 2yrs.
Thank you