Spondylitis TB Presentasi 2

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Spondylitis TB


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INTRODUCTION

• Evidence of spinal TB dates back to Egyptiantimes and has been docmented in !"""#yea$#oldmmmies%

• In &''() *e$cival *ott pblished the +$st mode$ndesc$iption of spinal defo$mity and pa$aplegia

$eslting f$om spinal TB%

• ,cco$ding to -.O/0""12) abot one thi$d of the3o$ld4s poplation is infected by 5ycobacte$im

TB) and ( million individals develop TB each

yea$%

Tuberculosis of the spine

in an Egyptianmumm


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Cont4d

• Spinal tbe$closis /often called *ott6s disease2 isby de+nition) an advanced disease) $e7i$ingmeticlos assessment and agg$essive systemicthe$apy%

• It is sally seconda$y to lng o$ abdominalinvolvement and may also be the +$stmanifestation of tbe$closis%

• Skeletal involvement of Tb has been $epo$ted to

occ$ in app$o8imately &"9 of all patents 3ithe8t$a#plmona$y tbe$closis)

#and half of these patients develop infection 3ithinthe spinal colmn%


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What Is Spinal Tuberculosis?

• Tuberculosis of the spine, also known as tuberculous spondylitis or Pott'sDisease, is a is an infection of the spine by the 5ycobacte$imtbe$closis bacte$im (TB).

• It sally infects anothe$ a$ea of the body +$st befo$e moving into

the spine%

• Spinal tbe$closis is $a$e in indst$iali:ed cont$ies bt stillcommon in developing nations%


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TB 5anifestations


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E8t$aplmona$y TB


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Symptoms

• Some of the most common symptoms of Pott's Disease are – Back pain

– !e"er

– #i$ht sweats

– %nore&ia

•

This leads to a si$nificant, unhealthy wei$htloss.

• The back pain is sometimes so painful patients will de"elop a mass in thespine which can cause – Tin$lin$

– #umbness

– eakness in the le$s – The deterioration and back pain will cause the sufferer to sit and walk in a ri$id, upri$ht

manner.


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Causes

• Pott's Disease, like other forms of TB, is caused by a mycobacterium whichis spread by way of blood or breathin$ droplets from an infected person into your lun$s where the bacteria will thri"e and $row if not killed by yourimmune system.

• nce in your blood stream, tuberculosis can infect a number of or$ans, each with their own set of symptoms and complications.


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*athogenesis

• In child$en) the main $ote of infection of spinaltbe$closis is th$ogh hematogenos sp$eadf$om a p$ima$y site of infection) 3hich is oftennkno3n%

• , concomitant active plmona$y disease isp$esent in ;!"9 of the cases%

• The mycobacte$im is deposited via the enda$te$ioles in the ve$teb$al body ad


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• -hile the infection is developing) the co$te8 is dis$pted and theinfection may sp$ead p and do3n)

# st$ipping the ante$io$ and poste$io$ longitdinal ligaments andthe pe$iostem f$om the f$ont and sides of the ve$teb$al bodies%

• This $eslts in loss of the pe$iosteal blood spply and dist$action

of the ante$olate$al s$face of the ve$teb$ae%

• Tisse nec$osis and b$eakdo3n of in=ammato$y cells $esltin a pa$aspinal abscess%

• *$og$essive nec$osis of bone leads to a kyphotic defo$mityand >ibbs fo$mation

• The infection then sp$eads to the ad


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Pott’s Disease


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Diagnosis

• Tbe$closis cases the disks in the spine to die and b$eak do3n)3hich often leads to the na$$o3ing of the ve$teb$a and theevental collapse of the spine%

• Radiog$aphs and CT scans of the spine a$e sometimes able to

sho3 tbe$closis of the spine) if p$esent) a bone biopsy 3ill bedone fo$ con+$mation%

• , test is often pe$fo$med to check a patient6s Enth$ocyteSedimentation Rate? a high ESR is a sign of *ott6s Disease%


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*hysical e8amination of thespine

• @ocalised tende$ness and pa$ave$teb$al msclespasms)

• Ayphotic defo$mity)

•

Cold abscess s3elling sins t$act• Ce$vical spine TB is a less common p$esentation)

#cha$acte$i:ed by neck pain stiness 3ithdysphagia st$ido$ mo$e common in lo3e$ce$vical spine involvement%


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S*IN,@ TUBERCU@OSIS

DI,>NOSIS

LAB STUDIES

5anto8 Tbe$clin skin test / p$i+ed p$oteinde$ivative F**DG2

ESR may be ma$kedly elevated /neithe$ speci+cno$ $eliable2%

E@IS, H fo$ antibody to mycobacte$ial antigen#1 )sensitivity of 1" J"9%

*CR H sensitivity of K"9 only%

#The ampli+ed M tuberculosis di$ect test is anisothe$mal t$ansc$iption#mediated ampli+cationthat ta$gets RN,%


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Cont4d

Microbiology stuies to con!rm iagnosis "

Miehl#Neelsen stainingH

#a 7ick and ine8pensive method%

Obtain bone tisse o$ abscess samples tostain fo$ acid#fast bacilli /,B2) isolateo$ganisms fo$ clt$e d$g ssceptibility%


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Cont4d

#ADI$L$%I&AL DIA%'$SIS

&% *@,IN R,DIO>R,*.

0% CT SC,N

% 5RI S*INEK% BONE SC,N

•. TB bacilli a$e $a$ely fond in CS) the$efo$e

imaging plays pivotal $ole in sggesting thediagnosis%


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SP$'D(LITIS TB& ) PA#A *E#TEB#AL ABS&ESS


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PLAI' #ADI$%#AP+

5o$e than !"9 of bone has to be dest$oyedbefo$e a lesion can be seen on P#$ay%

This p$ocess takes app$o8imately si8 months%

The classic P#$ay t$iad in spinal tbe$closis is

#p$ima$y ve$teb$al lesion)

#disc space na$$o3ing and

#pa$ave$teb$al abscess% Skip lesions as involvement of non contigos

ve$teb$ae /' &" 9 cases2%


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DIERENTI,@ DI,>NOSIS

• The die$ential diagnosis of the tbe$clos spineincldesH

&%S*IN,@ INECTIONS# pyogenic) b$cella fngal%

0%NEURO*,T.IC spine

%NEO*@,STIC commonly lymphoma metastasis

K%DE>ENER,TIQE

• No pathognomonic imaging signs allo3

tbe$closis to be $eadily distingished f$omothe$ conditions%

• Biopsy is de+nitive%


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CO5*@IC,TIONS O S*IN,@ TUBERCU@OSIS

• Ne$ological complications pa$aplegia and spinaldefo$mity a$e the most d$eaded complications oftbe$closis of spine%

• Ne$ological complications develop in the active

o$ healed stage of the disease%

• The se7elae of these t3o complications aectthe 7ality and span of life%

Cold abscess

Sinses

Seconda$y infection

atality


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• K#d$g $egimen

• Isonia:id and Rifampin /(#&0 bln2

• ,dd% +$st 0 months /+$st#line d$gs2)py$a:inamide) ethambtol) andst$eptomycin%

• The se of second#line d$gs isindicated in cases of d$g $esistanceci $o=oksasin

5EDIC,@ C,RE


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•

TRE,T5ENT&%chemote$apy conse$vative

0%chemote$apy ope$ation

5EDIC,@ C,RE


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◦ Ne$ologic de+cit /acte ne$ologic dete$io$ation)

pa$apa$esis) pa$aplegia2

◦ Spinal defo$mity 3ith instability o$ pain

◦ No $esponse to medical the$apy /contining

p$og$ession of kyphosis o$ instability2

◦ @a$ge pa$aspinal abscess

◦ Nondiagnostic pe$ctaneos needle biopsy sample

INDIA,SI O*ER,SI


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• ,nte$io$ $adical focal deb$idementand poste$io$ stabili:ation 3ithinst$mentation%0K) &"

• Involves the ce$vical spine) thefollo3ing facto$s IC,@ C,RE

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BR,CE *OST O*ER,SI


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@apo$an Aass


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T.,NA OU

Spondylitis TB Presentasi 2

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