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Introduction Epidemology Symptoms Age Frequency Mortality/Morbidity Risk factors Spinal Damage
Sex
Race
Diagnosis
Treatment
(TB OF SPINE)
ALTERNATE NAMES
Pott's syndrome Pott's caries Pott's curvature angular kyphosis kyphosis secondary to tuberculosis tuberculosis of the spine tuberculous spondylitis David's disease
DISTRIBUTION
The commonest area affected is T10 to L1. The lower thoracic region is the most
common area of involvement at 40 to 50%, with the lumbar spine in a close second place at 35 to 45%.
The cervical spine accounts for about 10%.
EPIDEMIOLOGY
Rare in the UK but in developing countries it
represents about 2% Tuberculosis worldwide accounts for 1.7 billion infections, and 2 million deaths per year. Over 90% of tuberculosis occurs in poorer countries, but a global resurgence is affecting richer ones.
EPIDEMIOLOGY
India, China, Indonesia, Pakistan and
Bangladesh have the largest number of cases The disease affects males more than females in a ratio of between 1.5 and 2:1. In the USA it affects mostly adults but in the countries where it is commonest it affects mostly children.
back pain Fever weight loss loss of appetite Imbalance Clumsiness sometimes even paralysis
to the spine. It can result in the collapse of vertebrae and fracturing of the bones. Abscesses and tissue formation can narrow the spinal canal, leading to neurological damage
RISK FACTORS
Endemic tuberculosis
HIV infection
X-rays magnetic resonance images (MRIs) CT scan guided biopsy Bone scans
DIFFERENTIAL DIAGNOSIS
Pyogenic osteitis of the spine. Spinal tumours
not show early disease as 50% of bone mass must be lost for changes to be visible on x-ray
MRI
MRI is useful to demonstrate the extent of
spinal compression and can show changes at an earlier stage than plain radiographs
used.
FUNCTIONAL DEFICIT
Paraparesis , Quadriparesis Paraplegia , Quadriplegia Early Onset Paraplegia Late Onset Paraplegia
(Meningitis / Arachnoiditis / Neuritis ) Fluid retention in the local tissues ( Oedema ) By disturbances of the blood supply to these delicate neural tissues ( Vascular thrombosis) Due to chronic stretching and attrition of the neural tissue
TREATMENT
Drug treatment
Bed rest
Spinal braces Surgery PT treatment
BED REST
the period of potential complications like developing neurological compression, enforced Bed Rest is needed. The duration of rest varies as per the case and is to be decided by the treating Physician
SPINAL BRACES
In a true sense the brace can not avoid vertical loading forces on the diseased part longer the brace better is the control of the spine more rigid the brace better is the control The brace must be appropriately selected, perfectly crafted and properly used
SURGERY
SURGERY
The surgery has 3 main aims.
1) Debridement : Removal of diseased tissue (pus, graunulation tissue, sequestra etc. ). 2)Neural Decompression : To relieve the Spinal Cord and nerves from the compressive effects of the disease. 3)Stabilization : Restoring strength and stability of the destroyed area by bone grafting ( fusion ) and if required by instrumentation ( using metalic implants for internal support of the spine
SURGERY
Sometimes the surgery may be needed for
correction of the spinal deformity and to reduce the effects of growth discrepancy produced by the disease
PT TREATMENT
During the period of recumbancy and support Requiring lengthy immobilization (lower limb
mobilization) Chest physiotherapy (in adult there may be also risk of respiratory infection and thrombosis)
PT TREATMENT
Minimization of for
stiffness atrophy (by exercises) pressure sores positioning careful bladder training programme
PT TREATMENT
Massage (maintain circulation and nutrition
PT TREATMENT
When healing has been taken place Treatment plane Strengthing of patient muscle Increase mobility in any joint in which it is impaired in except those in the area attack by the disease Low forcible strengthing and mobilization of spine Massage it should be given to the limb and disease area and may be given cautiously
EXERCISES
ROM of all joints Active movements done by patient of upper
limb No over stretch over pressure should be given in any trunk exercises Thorax need mobilizing with care and no movement should be undertaken which could put any strain on spine
EXERCISES
Especial care is necessory with regard to any
movement to take place most freely in the region for example specific trunk rotation and turning to the lower thoracic region Forward flexion should not be done
BREATHING EXERCISES
Costal diaphragmatic and apical breathing Most freely movements must be given to arm
and leg with simple resistance may be added but no over stretch when arm raise above the head
GENERAL MEASURES
SKIN CARE: Change posture every 2-4 hrly to avoid bed sores. Keep skin dry and clean. BLADDER CARE: CATHETERIZATION for urinary retention. BOWEL CARE: Avoid constipation by suitable diet and laxatives.
GENERAL MEASURES
PREVENTION OF CONTRACTURES
By regular passive movements. REHABILITATION By using wheel chair,standing frames,vocational training etc.
PREVENTION
As for all tuberculosis, BCG vaccination
CONTRAINDICATIONS
Any form of hanging Trunk rolling
gravity
PROGNOSIS
The progress is slow and lasts for months or
even years. Prognosis is better if caught early and modern regimes of chemotherapy are more effective. A study from London showed that diagnosis can be difficult and is often late.1
SUMMARY
TB is a challenging disease for the clinician Must have microbiology before starting
treatment more rapid lab tests? Need to encourage compliance Need for multidisciplinary approach to diagnosis and management and control Need shorter, better, cheap anti TB regimes
MOST IMPORTANT
When diagnosed promptly, treated
properly and adequately, tuberculosis of the spine has a good prospect of recovery. Earlier the disease is caught in its course the better it is !
GREAT SAYING