TB jkl

J.K.LaikDept.of orthopedics : 

J.K.LaikDept.of orthopedics OSTEOARTICULAR TUBERCULOSIS-SPINE

Regional Distribution : 

Regional Distribution Incidence : 30 million world wide Skeletal system-1-3%. Most common form - Vertebral tuberculosis (50%) Areas of predilection -Spine, hip, knee, foot,elbow, hand, shoulder, bursal sheaths Tuberculosis is monoarticular Multiple lesions - 10% of patients

General consideration : 

General consideration Tuberculosis is a chronic infectious disease caused by the tubercle bacilli. Involvement of bones and joints is secondary to lesions elsewhere. TB of bone and joint is merely local manifestation of a general disease. Most TB lesion of bone and joint appear at least 2 years of the onset of the primary lesion,

Pathogenic organism----tubercle bacillus : 

Pathogenic organism----tubercle bacillus Tubercle bacillus maybe either the human type or bovine type 1)Human type----involve the lung, there is a history of contact with the patient of open pulmonary TB 85% 2)Bovine type----involve the intestine or alimentary tract , 25% because ①pasteurization of the milk; ②sufficient inspection of dairy

Pathology and pathogenesis : 

Pathology and pathogenesis

Pathology and pathogenesis : 

Pathology and pathogenesis One artery supply both vertebra Paradiscal type more common

Skeletal Tuberculosis : 

Skeletal Tuberculosis Paraspinal and psoas abscesses can develop, with extensions to the surface or adjacent tissues Patients present with local pain, constitutional symptoms, or paraplegia secondary to cord compression.

Neurological menifestation : 

Neurological menifestation

Causes of neurological complication : 

Causes of neurological complication Inflammatory Mechanical

Clinical features : 

Clinical features 1)History with other TB lesion such as pulmonary, intestinal, or renal TB should be detailed reviewed. 2)Contacted history: possible TB of family members An insidious onset: merely local manifestation of a general disease onset is usually insidious. The illness gradually develops with a long history. Almost no patient has exact time of onset.

Local symptoms and signs : 

Local symptoms and signs Monoarticular or mono-osseous involvement: 95.9% Night cry Stiffness Early stage: limitation of motion  Deformity: bone destruction, gibbus result from the lesion of thoracolumbar spine,

Investigations : 

Investigations Mantoux Test Positive reaction ->1 month Negative test, in general, rules out the disease. Negative-immune deficiency states Nuclear Scan MRI Biopsy Whenever there is doubt (particularly in the early stages)

Management : 

Management

Principles of Treatment ofOsteoarticular Tuberculosis : 

Principles of Treatment ofOsteoarticular Tuberculosis Rest, Immobilization, and Braces Antitubercular Chemotherapy Indications for Operative Treatment Neurological com-plications which failed to respond to conserva-tive therapy/too advanced: Decompression (± fusion) Failure of response after 3 to 6 months of nonoperative treatment: Debridement (± fusion) Doubtful diagnosis. Mechanical instability after healing:Fusion Recurrence of disease or of neural complication: Debridement ± decompression ± fusion

Principles of Treatment ofOsteoarticular Tuberculosis : 

Principles of Treatment ofOsteoarticular Tuberculosis Indications for Operative Treatment Anterior transposition of cord through extrapleural anterolateral approach for neural complications due to severe kyphosis. Laminectomy has no place in tuberculosis of spine except for extradural granuloma or tuberculoma presenting as “spinal tumour syndrome’, or a case of old healed disease (without much deformity) presenting with secondary “vertebral canal stensosis”,

Anti tubercular therapy : 

Anti tubercular therapy Intensive Phase: All replicating sensitive myco- bacteria continuation phase: Persisters, slow growing or intermittently growing or dormant or intracellular mycobacteria

Duration of therapy : 

Duration of therapy Controversial Short course/Long course Multibacillary/paucibacillary Rapid multipliers/slow multipliers

Immuno modulators : 

Immuno modulators

Implants in TB : 

Implants in TB Can be used

Slide 22: 

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