Investigation and Treatment for TB/Tuberculosis Spine

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

Pediatric Orthopedics in Children

Tuberculosis of the Spine

Pediatrics Orthopedics

Limb length inequality

Elbow Region Fractures

Scoliosis

Tuberculosis of The Spine

Elbow Ossification Centers In Child

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TUBERCULOSIS OF THE SPINE

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TB Spine Introduction

Symptoms For patient with TB Spine

Dr A.Johari.
Consulting Pediatric Orthopedic
Consultant at Bombay Hospital ,
B.J.Wadia Children's Hospital ,
Children's Orthopedic Centre.

Q. How should one investigate a case of TB spine ?

A. Radiological:

X rays of the spine : show a reduced disc space and loss of definition of the paradiscal margins. Presence of paravertebral, prevertebral shadow indicates that an abscess is present. The central body affections appear as a flattening of vertebrae. The anterior type appear as wedged vertebrae.
MRI or CT scan are used to define the cause of neurological deficit and status of the cord.

Blood investigations: CBC, ESR help in diagnosis.

Other investigations: X-ray Chest may also aid in the diagnosis.

As skeletal tuberculosis is paucibacillary, cultures are usually negative. Confirmation of diagnosis is on histopathology.

Q. What is the treatment of TB spine ?

A. Anti-tuberculous chemotherapy and bed rest and later protective bracing and mobilization form the mainstay of treatment. Bactericidal drugs are preferred and short course chemotherapy is under trial.

Operative intervention is required when:

There is a progressive neurological deficit.
No response to conservative management.
Persistent neurological deficit.
Decompression of large abscesses.
Involvement of more number of contiguous vertebrae and a more severe deformity may be anticipated.

The various surgeries are:

Draining of an abscess.
Decompression and scraping of the infected lesion.
Decompression with bone grafting.
In presence of a deformity correction of the deformity and stabilization by internal fixation and fusion.

REFERENCES:

Tuli SM. Tuberculosis of the skeletal system. Jaypee Brothers, 1st Edn.,1991
Hodginson AR. Stock FE. Anterior spinal fusion for the treatment of tuberculosis of the spine. J. Bone Joint Surg. 1960, 42 - A:295.
Hodgson AR, Skinses OK, Leong CY. Pathogenesis of Potts paraplegia. J. Bone Joint Surg. 1967, 49-A:1147.
Hallock H. Jones B. Tuberculosis of the Spine. J Bone Joint Surg. 1954, 36-A:219.
Griffiths DL. Short course chemotherapy in the treatment of surgical tuberculosis : A report from the Medical Research Council's Working Party. J Bone Joint Surg. 1986, 68-A:158.
Evarts MC. Surgery of the musculo-skeletal system. Churchill Livingstone, 2nd Edition, 1990.
Cauthen JC. Lumbar spine surgery. Williams and Wilkins, 1st Edition 1983.

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