This document discusses tuberculosis of the spine (Pott's disease). It is a tertiary lesion caused by bloodborne tuberculosis infection settling in the vertebral body, causing inflammation and granuloma formation. This can lead to caseous necrosis, abscess formation, and bone and disc destruction. Clinical features include back pain, stiffness, deformity, and potentially paraplegia. Diagnosis involves radiological exams showing vertebral body destruction and abscesses. Treatment involves anti-tubercular therapy along with spinal immobilization and surgery if needed to decompress the spinal cord in cases of paraplegia.

1. TUBERCULOUSTUBERCULOUS
SPONDYLITISSPONDYLITIS
NISHANTH M KNISHANTH M K
2008 MBBS2008 MBBS

2. TUBERCULOSIS OF SPINETUBERCULOSIS OF SPINE
 A TERTIARY LESION OF TB INFECTIONA TERTIARY LESION OF TB INFECTION
 MOST COMMON TYPE OF SKELETAL TBMOST COMMON TYPE OF SKELETAL TB
 BLOOD BORNE INFECTION SETTLES INBLOOD BORNE INFECTION SETTLES IN
AVERTEBRAL BODYAVERTEBRAL BODY
 C/C INFLAMMATORY REACTIONC/C INFLAMMATORY REACTION
 MICROSCOPIC LESION – GRANULOMAMICROSCOPIC LESION – GRANULOMA
FORMATIONFORMATION
 SMALL PATCHES OF CASEOUSSMALL PATCHES OF CASEOUS
NECROSISNECROSIS

3. CONT……………………….CONT……………………….
 COALESCE TO FORM YELLOWISH MASSCOALESCE TO FORM YELLOWISH MASS
 CENTER BREAKDOWN, FORM COLDCENTER BREAKDOWN, FORM COLD
ABCESSABCESS
 PUSS AND NECROSED BONE FRAGMENTSPUSS AND NECROSED BONE FRAGMENTS
 COLD ABSCESS MAY INVOLVE SOFTCOLD ABSCESS MAY INVOLVE SOFT
TISSUE AND SINUS FORMATIONTISSUE AND SINUS FORMATION
 COLLAPSE OF IVD, GIBBUS FORMATIONCOLLAPSE OF IVD, GIBBUS FORMATION

4. GRANULOMAGRANULOMA

5. CLINICAL FEATURESCLINICAL FEATURES
 PAINPAIN
 STIFFNESSSTIFFNESS
 COLD ABSCESSCOLD ABSCESS
 PARAPLEGIAPARAPLEGIA
 DEFORMITYDEFORMITY

6. EXAMINATIONEXAMINATION
 GAITGAIT
 ATTITUDE AND DEFORMITYATTITUDE AND DEFORMITY
 PARA-VERTEBRAL SWELLINGPARA-VERTEBRAL SWELLING
 TENDERNESSTENDERNESS
 MOVEMENTMOVEMENT
 NEUROLOGICAL EXAMINATIONNEUROLOGICAL EXAMINATION
 GENERAL EXAMINATIONGENERAL EXAMINATION

7. INVESTIGATIONSINVESTIGATIONS
 RADIOLOGICAL EXAMINATIONRADIOLOGICAL EXAMINATION
 REDUCTION IN DISC SPACEREDUCTION IN DISC SPACE
 DESTRUCTION OF VERTEBRAL BODYDESTRUCTION OF VERTEBRAL BODY
 EVIDENCE OF COLD ABSCESSEVIDENCE OF COLD ABSCESS
 RAREFACTIONRAREFACTION
 SIGNS OF HEALINGSIGNS OF HEALING

8. LOSS OF DISC SPACE

9. EROSION STARTS

10. Central destruction of the
lower half of the vertebral
body, only seen on the
anteroposterior view. The
disc space is slightly
narrowed

11. . The lower disc space is
narrowed .the upper space
is almost normal. A small
lytic defect is present on
the right side of the body
below, and there is a small
Para vertebral abscess.

12. FUSIFORM ABSCESS TENSE ABSCESS

13. RETROPHARYNGEAL
ABSCESS

14. CT scan of a child
showing destruction of
the neural arch on both
sides, as well as of the
vertebral body. Arrows,
anterior spinal abscess.
CT SCAN

15. MRIMRI
• SHOWS EXTENT OF
CORD COMPRESSION
•CONDITION OF
UNDERLYING
NEURAL TISSUES

16. MYELOGRAPHYMYELOGRAPHY
There is narrowing of theThere is narrowing of the
disc space between the firstdisc space between the first
and second &second andand second &second and
third lumbar vertebraethird lumbar vertebrae

17. BIOPSYBIOPSY
 CT GUIDED NEEDLE BIOPSYCT GUIDED NEEDLE BIOPSY
 OPEN BIOPSYOPEN BIOPSY

18. OTHER INVESTIGATIONSOTHER INVESTIGATIONS
 ESRESR
 MANTOUX TESTMANTOUX TEST
 ELISA TESTELISA TEST
 CHEST X -RAYCHEST X -RAY

19. DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS
 BACK PAINBACK PAIN
1.1. TRAUMATICTRAUMATIC
2.2. SECONDARIESSECONDARIES
3.3. PROLAPSED DISCPROLAPSED DISC
4.4. ANK.SPONDYLITISANK.SPONDYLITIS

20.  NEUROLOGICAL DEFICITNEUROLOGICAL DEFICIT
1.1. SPINAL TUMOURSPINAL TUMOUR
2.2. TRAUMATICTRAUMATIC
3.3. SECONDARIES IN SPINESECONDARIES IN SPINE

21. TREATMENTTREATMENT
 AIMAIM
1.1. TO ACHIEVE HEALINGTO ACHIEVE HEALING
2.2. TO PREVENT ,DETECT AND TREATTO PREVENT ,DETECT AND TREAT
EARLY ANY COMPLICATION LIKEEARLY ANY COMPLICATION LIKE
PARAPLEGIAPARAPLEGIA

22.  ANTI TUBERCULAR THERAPYANTI TUBERCULAR THERAPY
 GENERAL CAREGENERAL CARE
 CARE OF SPINECARE OF SPINE
 TREATMENTOF COLD ABSCESSTREATMENTOF COLD ABSCESS

23. COMPLICATIONSCOMPLICATIONS
 COLD ABSCESSCOLD ABSCESS
 NEUROLOGICAL COMPRESSIONNEUROLOGICAL COMPRESSION

24. POTT’S PARAPLEGIAPOTT’S PARAPLEGIA
MOST COMMON IN TB OFMOST COMMON IN TB OF
DORSAL SPINEDORSAL SPINE
--spinal canal is narrowestspinal canal is narrowest
here.here.
INCIDENCE-20%INCIDENCE-20%

25. PATHOLOGYPATHOLOGY
 PRESSURE ON NEURAL TISSUES WITHINPRESSURE ON NEURAL TISSUES WITHIN
THE CANAL BY PRODUCTS OF DISEASEDTHE CANAL BY PRODUCTS OF DISEASED
VERTEBRAVERTEBRA
1.1. INFLAMMATORY EDEMAINFLAMMATORY EDEMA
2.2. EXTRADURAL PUS AND GRANULATIONEXTRADURAL PUS AND GRANULATION
TISSUETISSUE
3.3. SEQUESTRASEQUESTRA
4.4. INTERNAL GIBBUSINTERNAL GIBBUS
5.5. INFARCTION OF SPINAL CORDINFARCTION OF SPINAL CORD
6.6. EXTRADURAL GRANULOMAEXTRADURAL GRANULOMA

26. INTERNAL
GIBBUS
SPINAL CORD

27. TYPESTYPES
1.1. EARLY ONSET PARAPLEGIA-WithinEARLY ONSET PARAPLEGIA-Within
2 years of onset of disease2 years of onset of disease
2.2. LATE ONSET PARAPLEGIA-At leastLATE ONSET PARAPLEGIA-At least
2 years after onset of disease2 years after onset of disease

28. CAUSESCAUSES
EARLY ONSET PARAPLEGIAEARLY ONSET PARAPLEGIA
 INFLAMMATORY CAUSESINFLAMMATORY CAUSES
1.1. ABSCESSABSCESS
2.2. GRANULATION TISSUEGRANULATION TISSUE
3.3. CIRCUMSCRIBED TB FOCUSCIRCUMSCRIBED TB FOCUS
4.4. POSTERIOR SPINAL DISEASEPOSTERIOR SPINAL DISEASE
5.5. INFECTIVE THROMBOSIS OF SPINALINFECTIVE THROMBOSIS OF SPINAL
BLOOD SUPPLYBLOOD SUPPLY

29.  MECHANICAL CAUSESMECHANICAL CAUSES
1.1. SEQUESTRUM IN THE CANALSEQUESTRUM IN THE CANAL
2.2. INFECTED DEGENERATED DISC IN THEINFECTED DEGENERATED DISC IN THE
CANALCANAL
3.3. PATHOLOGICAL DISLOCATION –A RIDGEPATHOLOGICAL DISLOCATION –A RIDGE
OF BONE PRESSING ON THE CORDOF BONE PRESSING ON THE CORD

30.  LATE ONSET PARAPLEGIALATE ONSET PARAPLEGIA
1.1. RECURRENCE OF DISEASERECURRENCE OF DISEASE
2.2. INTERNAL GIBBUSINTERNAL GIBBUS
3.3. FIBROUS SEPTAE FOLLOWING HEALINGFIBROUS SEPTAE FOLLOWING HEALING

31. CLINICAL FEATURESCLINICAL FEATURES
 ONSET IS USUALLY GRADUAL BUTONSET IS USUALLY GRADUAL BUT
IN SOME IT IS SUDDENIN SOME IT IS SUDDEN
 TUBERCULAR PARAPLEGIA-spastic atTUBERCULAR PARAPLEGIA-spastic at
firstfirst

CLONUS (ankle or patellar)CLONUS (ankle or patellar) ++

32. STAGES OF PARALYSISSTAGES OF PARALYSIS
 MUSCLE WEAKNESSMUSCLE WEAKNESS
 PARAPLEGIA IN EXTENSIONPARAPLEGIA IN EXTENSION
 PARAPLEGIA IN FLEXIONPARAPLEGIA IN FLEXION
 COMPLETE FLACCID PARAPLEGIACOMPLETE FLACCID PARAPLEGIA

33. GRADES OF POTTSGRADES OF POTTS
PARAPLEGIAPARAPLEGIA
GRADE I-GRADE I-
PATIENT ISPATIENT IS UNAWARE OF NEURALUNAWARE OF NEURAL
DEFICIT,PHYSICIAN DETECTSDEFICIT,PHYSICIAN DETECTS
BABINSKI +& PATELLAR OR ANKLEBABINSKI +& PATELLAR OR ANKLE
CLONUS ON EXAMINATIONCLONUS ON EXAMINATION

34.  GRADE IIGRADE II
PATIENT PRESENTS WITHPATIENT PRESENTS WITH
COMPLAINTS OFCOMPLAINTS OF
CLUMSINESS,INCOORDINATION ORCLUMSINESS,INCOORDINATION OR
SPASTICITY WHILE WALKING BUTSPASTICITY WHILE WALKING BUT
MANAGES TO WALK WITH ORMANAGES TO WALK WITH OR
WITHOUT SUPPORTWITHOUT SUPPORT

35.  GRADE IIIGRADE III
PATIENT IS NOT ABLE TO WALKPATIENT IS NOT ABLE TO WALK
BECAUSE OF SEVERE WEAKNESS.ONBECAUSE OF SEVERE WEAKNESS.ON
EXAMINATION HE HAS PARAPLEGIAEXAMINATION HE HAS PARAPLEGIA
ON EXTENSION.THERE MAY BEON EXTENSION.THERE MAY BE
PARTIAL LOSS OF SENSATION.PARTIAL LOSS OF SENSATION.

36.  GRADE IVGRADE IV
PATIENT IS UNABLE TO WALKPATIENT IS UNABLE TO WALK
&HAS PARAPLEGIA IN FLEXION&HAS PARAPLEGIA IN FLEXION
WITH SEVERE MUSCLEWITH SEVERE MUSCLE
SPASM.THERE IS NEAR COMPLETESPASM.THERE IS NEAR COMPLETE
LOSS OF SENSATION WITHLOSS OF SENSATION WITH
SPHINCTER DISTURBANCESSPHINCTER DISTURBANCES

37. INVESTIGATIONSINVESTIGATIONS
 X-RAYX-RAY
 MYELOGRAPHYMYELOGRAPHY
 CTCT
 MRIMRI

38. TREATMENTTREATMENT
 AIMAIM
 TO PROMOTE RECOVERYTO PROMOTE RECOVERY
 TO ACHIEVE HEALINGTO ACHIEVE HEALING
 TO UNDERTAKE REHABILITATIVETO UNDERTAKE REHABILITATIVE
MEASURESMEASURES

39. TYPESTYPES
CONSERVATIVECONSERVATIVE OPERATIVEOPERATIVE
CONSERVATIVE
1. ANTI TUBERCULAR CHEMOTHERAPY
2. ABSOLUTE SPINE REST
3. CARE OF THE PARALYSED LIMBS
4. REPEATED NEUROLOGICAL EXAMINATION
IF ANY IMPROVEMENT TREATMENT IS CONTINUED

40.  OPERATIVE TREATMENTOPERATIVE TREATMENT
INDICATIONSINDICATIONS
ABSOLUTEABSOLUTE
1.1. PARAPLEGIA OCCURING DURING USUALPARAPLEGIA OCCURING DURING USUAL
CONSERVATIVE TREATMENTCONSERVATIVE TREATMENT
2.2. NOT RESPONDING TO TREATMENTNOT RESPONDING TO TREATMENT
3.3. RAPID ONSETRAPID ONSET
4.4. UNCONTROLLED SPASTICITYUNCONTROLLED SPASTICITY
5.5. SEVERE PARAPLEGIA WITHSEVERE PARAPLEGIA WITH
MOTOR OR SENSORY LOSS FOR >6MOTOR OR SENSORY LOSS FOR >6
MONTHSMONTHS
TOTAL MOTOR LOSS>1 MONTHTOTAL MOTOR LOSS>1 MONTH

41.  RELATIVERELATIVE
1.1. RECURRENT PARAPLEGIARECURRENT PARAPLEGIA
2.2. ONSET IN OLD AGEONSET IN OLD AGE
3.3. PAINFUL PARAPLEGIAPAINFUL PARAPLEGIA
4.4. COMPLICATIONS SUCH AS UTI ANDCOMPLICATIONS SUCH AS UTI AND
STONESSTONES

42. OPERATIVE PROCEDURESOPERATIVE PROCEDURES
AIMAIM
TO REMOVE AGENTS CAUSING COMPRESSION ONTO REMOVE AGENTS CAUSING COMPRESSION ON
NEURAL STRUCTURESNEURAL STRUCTURES
1.1. COSTOTRANSVERSECTOMYCOSTOTRANSVERSECTOMY
2.2. ANTERO LATERAL DECOMPRESSIONANTERO LATERAL DECOMPRESSION
3.3. RADICAL DEBRIDEMENT ANDRADICAL DEBRIDEMENT AND
ARTHRODESISARTHRODESIS
4.4. LAMINECTOMYLAMINECTOMY

43. Costo-transversectomy Antero-lateral decompression

44. PROGNOSISPROGNOSIS
 AGE-AGE-CHILDRENCHILDREN
 DURATION OF PARAPLEGIA-DURATION OF PARAPLEGIA-
LONG STANDINGLONG STANDING
 SEVERITYSEVERITY--MOTOR PRALYSISMOTOR PRALYSIS
--SPHINCTERSPHINCTER
INVOLVEMENTINVOLVEMENT
 ACUTE ONSET OF PARAPLEGIAACUTE ONSET OF PARAPLEGIA
 SUDDEN PROGRESSSUDDEN PROGRESS