TUBERCULOSIS OF SPINE

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Presentation Description

General and simple presentation of tuberculosis of spine on incidence, pathology, complications, management. This presentation is suitable for PGs, Ugs. spinal tuberculosis, potts spine, tb spine, caries spine, spine infection, kyphosis

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Corbel:

Dr.N.Somasekhar Reddy M.S.Ortho ., MCh Orth (Liverpool) Sr.Consultant Orthopaedic surgeon , Dr.A.Mohan krishna M.S.Ortho ., MCh Orth (U.K) Consultant Orthopaedic surgeon,

Wingdings 2:

2

Wingdings 3:

Hameatogenous spread

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Granuloma formation Tissue necrosis & inflammatory response Paraspinal Abscess Localized Track along tissue planes Progressive necrosis of vertebral body- Kyphotic deformity Adjacent vertebral bodies under the longitudinal ligaments Along the fascial planes Ex: Psoas abscess

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Psoas abscess

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Compressive Early onset Paraplegia ACTIVE With in 2 years Late onset paraplegia HEALED After 2 years Tubercular granulation tissue, Sequestra, abscess, Caseous tissue Stretching of cord, Myelomalacia, Internal gibbus,

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Depends on the severity of involvement of long tracts

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A Complete paralysis No motor or sensory function preserved below lesion B   Sensory function only below the injury level Preservation of any demonstrated sensation only C Incomplete motor function below injury level Preservation of motor capacity (Nonfunctional) sensations may or may not be present D  Fair to good motor function below injury level Preservation of useful motor capacity Normal function Complete return of motor and sensory modalities/ reflexes may be abnormal.

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Cold abscess / sinuses Constitutional symptoms: fever, wt loss, night cries (Children) Back pain is earliest & common symptom Weakness paraplegia

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> 50% of bone destruction before seen radiologicall y Classic Radiological triad Primary Vertebral lesion Disc space narrowing Paravertebral abscess Typical tubercular spondylitic features in long standing paraspinal abscesses Aneurysmal phenomenon Fusiform paraspinal soft tissue shadow Skip lesions 7-10%

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CT or USG guided aspiration : HPE / Microbiology / Culture

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3(HRZE) / 3(HRZS) + 3(HRZ)+12(HR) Paediatric age group, streptomycin (for 2 months) replaces ethambutol to avoid optic neuropathy 4(HRZE) + 14(HR)

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SURGERY INDICATIONS Decompression (+/- Fusion) Advance disease, failure to respond to conservative therapy Debridement +/- decompression +/- fusion Recurrence of disease or of neural complication Anterior transposition of cord ( extrapleural anterolateral approach) Severe Kyphosis (>60 deg) + neural deficits . laminectomy Extradural granuloma / tuberculoma / Old healed disease presenting as secondary canal stenosis / posterior spinal disease.

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Thank you

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