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The document discusses tuberculosis of bones and joints, specifically focusing on Pott's disease or spinal tuberculosis. It covers the pathogenesis, clinical presentation, diagnosis and treatment of spinal tuberculosis, including typical symptoms, imaging findings, diagnostic tests and the role of anti-tubercular medication and surgery.

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8 views14 pages

Wa0009.

The document discusses tuberculosis of bones and joints, specifically focusing on Pott's disease or spinal tuberculosis. It covers the pathogenesis, clinical presentation, diagnosis and treatment of spinal tuberculosis, including typical symptoms, imaging findings, diagnostic tests and the role of anti-tubercular medication and surgery.

Uploaded by

jalional20
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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TUBERCULOSIS OF BONES AND

JOINTS

By nivedita manjhi
Group 1
POTT’S DISEASE ( SPINE TUBERCULOSIS )

• The incidence of extrapulmonary TB (EPTB) is 3%, among which 10% of


cases are skeletal TB. Spinal TB cases constitute 50% of skeletal tubercular
infections.
• The World Health Organisation (WHO) reported an incidence of 10.4 million
new cases of tuberculosis in 2016, among which 46.5% of cases were reported
from the South East Asian Region alone.
• Some known risk factors for TB include prolonged exposure to infected
patients, immunodeficiencies (HIV, alcohol, drug abuse), overcrowding,
malnutrition, poverty, and lower socio-economic situation.
PATHOPHYSIOLOGY

• Spinal TB is usually secondary to hematogenous spread from a primary site of infection


(most commonly the lungs).
• The paradiscal vessels typically supply the subchondral bone on either side of the disc
space and therefore, the most common site of vertebral involvement is paradiscal. The
other patterns of involvement include central (with predominant vertebral body
involvement), posterior (involving the posterior structures primarily) and non-osseous
involvement (presenting with the abscess).
• Progressive vertebral destruction leads to spinal kyphotic deformity and instability.
CLINIC AL PRESENTATION

• COLD ABSCESS
• abscesses typically lack all the inflammatory signs obvious in
abscesses; and hence the name.
• In the cervical spine, they can present in the retropharyngeal space,
anterior or posterior triangles of the neck or axilla.
• In the thoracic spine, they may present as pre- or paravertebral
abscesses; or over the chest wall.
• In the lumbar spine, they may track down along the psoas muscle,
Petit's triangle, Scarpa's triangle, or the gluteal region.[
DEFORMITY

• appearance of kyphotic deformity has been classified as knuckle (one


vertebral involvement), gibbus (two vertebrae) and rounded kyphus
(more than three vertebrae).
• Owing to the greater involvement of the anterior spinal column in TB,
the spinal column progressively develops a kyphotic orientation;
especially in the thoracic and thoracolumbar spine.
• It is observed that kyphotic deformity greater than 60 degrees leads to
significant disability and can potentially inflict neurological deficits
NUEROLOGIC AL DEFICIT

• initial compression in TB is secondary to vertebral body collapse,


leading to anterior spinal tract involvement (exaggerated deep tendon
reflexes and Babinski sign
• further progression on to UMN-type motor deficit). Further on, the
lateral spinal tracts are progressively involved (with loss of crude touch,
pain, and temperature);
• Followed by posterior column deficit (sphincter disturbances and
complete sensory loss
ATYPIC AL SIGNS

• intervertebral disc prolapse,


• isolated abscess without skeletal involvement,
• pure intraspinal granulomas. Similarly, atypical radiol
skip lesions, concentric vertebral collapse,
circumferential vertebral involvement, isolated posterior arch
involvement
ivory vertebra,
Isolated meningeal, neural or perineural involvement without any
vertebral destruction and multifocal osseous lesions
DAIGNOSIS

• GOLD STANDARD - culture of myobacterium


• Imaging test
• Plain radiograph - – can present with disc space reduction, endplate
rarefaction, vertebral body destruction, instability, and spinal deformity.
The chest x-ray is also an important investigation, as up to thirds of
these patients with spinal TB can also have a concomitant pulmonary
disease.
• Computed tomography - types of vertebral destructive lesions by CT in
spinal TB include fragmentary, osteolytic, subperiosteal, and localized
sclerosis.
• typical MRI findings including multi-segment sub-ligamentous collection, the
occurrence of well-defined para/pre-vertebral mass or abscess with relatively
thickened abscess walls, relatively spared disc space until the later stages of the
disease and heterogeneous enhancement of vertebral body can help in
distinguishing tubercular spondylodiscitis from other pyogenic infections
• Nuclear imaging: 18 F-fluorodeoxyglucose (18F-FDG) labeled positron
emission tomography (PET) scan provides evidence of functional activity in the
involved tissues, based on the rationale that 18F-FDG is known to accumulate
in macrophages at the inflammation site.[These modalities cannot help in
distinguishing tubercular infections from malignancy or other pyogenic
infections.
LAB TEST

• ESR
• SEROLOGICAL TEST
• AFB staining
• TB culture
• Molecular testing and PCR
• Histopathological evaluation
LATENT TUBERCULOSIS DAIGNOSIS

Mantaux test (40% to 55% sensitivity and 75% specificity): Skin


hypersensitivity test (purified protein derivative [PPD]) has been
recommended as a low-cost test in developing nations; nevertheless it is
not an accurate test in endemic countries or immunodeficient patients.
• Interferon-gamma release assay (50% to 65% sensitivity and 85%
specificity): Measuring interferons produced in response to tubercular
antigens; not useful in endemic regions.
• Whole blood-based enzyme-linked immunosorbent assay
TREATMENT

• Medical treatment is the mainstay but surgical intervention may be


required.
• The possibility of multiple drug-resistant TB should be considered.
• Immobilisation of the spine is usually for two or three months.
• Surgery is reserved for select cases of progressive deformity or where
neurological deficit is not improved by anti-tubercular treatment.
• Multidisciplinary approaches to diagnosis and management can improve
outcomes for both
• THANK YOU

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