This document discusses tuberculosis (TB) of the spine. It notes that TB most commonly affects the thoracic region of the spine. Early infection begins in the vertebral body and spreads along ligaments, potentially causing multilevel involvement. Chronic infection can cause severe kyphosis and spinal cord compression. Presentation includes back pain and potential neurological deficits. Imaging shows characteristic vertebral body involvement and potential abscesses. Treatment involves anti-TB drugs for 12 months without complications, while surgery is needed for neurological deficits, instability, or large kyphosis.
This document discusses tuberculosis (TB) of the spine. It notes that TB most commonly affects the thoracic region of the spine. Early infection begins in the vertebral body and spreads along ligaments, potentially causing multilevel involvement. Chronic infection can cause severe kyphosis and spinal cord compression. Presentation includes back pain and potential neurological deficits. Imaging shows characteristic vertebral body involvement and potential abscesses. Treatment involves anti-TB drugs for 12 months without complications, while surgery is needed for neurological deficits, instability, or large kyphosis.
This document discusses tuberculosis (TB) of the spine. It notes that TB most commonly affects the thoracic region of the spine. Early infection begins in the vertebral body and spreads along ligaments, potentially causing multilevel involvement. Chronic infection can cause severe kyphosis and spinal cord compression. Presentation includes back pain and potential neurological deficits. Imaging shows characteristic vertebral body involvement and potential abscesses. Treatment involves anti-TB drugs for 12 months without complications, while surgery is needed for neurological deficits, instability, or large kyphosis.
This document discusses tuberculosis (TB) of the spine. It notes that TB most commonly affects the thoracic region of the spine. Early infection begins in the vertebral body and spreads along ligaments, potentially causing multilevel involvement. Chronic infection can cause severe kyphosis and spinal cord compression. Presentation includes back pain and potential neurological deficits. Imaging shows characteristic vertebral body involvement and potential abscesses. Treatment involves anti-TB drugs for 12 months without complications, while surgery is needed for neurological deficits, instability, or large kyphosis.
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TB SPINE
Epidemiology Increasing incidence due to increasing number of migrant workers 15% of patient with PTB will have extrapulmonary involvement o Spine (thoracic region) most commonly affected Anatomy Early infection o Begins at the metaphysis of vertebral body o Spreads under anterior longitudinal ligament & leads to 1. Contagious multilevel involvement 2. Skip lesion 3. Paraspinal abscess formation o Usually does not affect disc spaces o In children, the disc can be the primary site Anatomy Chronic infection o Severe kyphosis and anterior vertebral collapse (gibbus formation) o Risk of spinal cord compression, leading to paraplegia o Late-onset paraplegia due to osteophytes deposition & other chronic degenerative changes o Formation of cold abscess Presentation Symptoms o Constitutional symptoms o Back pain o Neurologic abnormalities (cervical spine TB > thoracic spine TB) Signs o Bony deformity o Neurological deficit 1. Mechanical pressure on cord 2. Mechanical instability 3. Stenosis from ossification of ligamentum flavum Imaging Chest X-ray Spine radiographs o Early infection shows anterior vertebral body involvement with sparing of disc space, demineralization of end-plate & paravertebral abscess formation o Late infection shows disc space destruction, lucency and compression of adjacent vertebral bodies & kyphosis o Risk factors for buckling collapse 1. Retropulsion 2. Subluxation 3. Lateral translation 4. toppling Imaging Spine X-ray Lytic destruction of anterior portion of vertebral body Increased anterior wedging Collapse of vertebral body Reactive sclerosis on a progressive lytic process Enlarged psoas shadow with or without calcification Fusiform paravertebral shadows suggest abscess formation Imaging MRI (to demonstrate the extension into soft tissue) o Presence of smooth walled abscess & breaching of epidural space o End-plate disruption o Paravertebral soft tissue shadow o Bright signal of the disc in T2 o Spinal cord changes Imaging CT o For types of destruction 1. Fragmentary 2. Osteolytic 3. Subperiosteal 4. Sclerotic Other Ix Biopsy and culture Blood Ix Inflammatory markers TB workup Treatment Multidisciplinary effort o Orthopedics surgeon o Neurosurgeons o Rehab team Treatment Non-operative 1. No neurologic deficit 2. No persistent symptoms
Pharmacological agents (anti-TB therapy), typically 9-12 months
Spinal orthosis Treatment Operative 1. Neurologic deficit 2. Spinal instability 3. Kyphosis correction > 60 in adults Progressive in children 4. Large paraspinal abscess 5. Advanced disease with caseating preventing access by Abx 6. Failure to pharmacological therapy 7. Panvetebral lesion Treatment Advantages of surgical treatment o Less progressive kyphosis o Earlier healing o Decreased sinus formation o Improved neurologic recovery
