Tuberculosis of The Spine

Jagdish Kathwate
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Tuberculosis of The Spine - Patient Education
What is Tuberculosis of the spine?
Tuberculosis of the spine also known as Koch's spine and Tuberculous Vertebral Osteomyelitis is the commonest form of skeletal tuberculosis and accounts for 88% of chronic vertebral infections.

What is Incidence of Koch's spine?
There are 30 million cases of tuberculosis in the world. 6 million cases of sputum positive tuberculosis are in India. 1-3% cases have skeletal tuberculosis.

How does it occur?
Vertebral affection occurs due to hematogenous dissemination from a primary infected organ (usually pulmonary or lymph node). The primary focus may be active or quiescent, apparent or latent.

What are type of Tuberculosis of the spine?
Pathologically, tuberculosis occurs in two forms:
The granulomatous inflammation characterized by granulation tissue and tubercles.
Caseous type associated with abscess and sinus formation.

What are symptoms of Tuberculosis of the spine?
Constitutional symptoms in the form of fever, malaise, loss of weight, loss of appetite may be present. Neurological complications occur in 10 - 30% of cases. They are of two types:
Early Onset: which occurs within 2 years of disease. Inflammation, edema, abscess, caseous tissue or sequestrum from vertebral bodies producing neural compression. The prognosis of early onset paresis is good following appropriate management.
Late onset paresis: which occurs after 2 years of onset of disease and result from stretching of the cord over an internal gibbus causing myelomalacia and gliosis of the cord, or may result from mechanical pressure on the cord or recrudescence of disease. The prognosis is poor, as permanent degenerative changes may have occurred in the cord.

What investigations are required for diagnosis Tuberculosis of the spine ?
Radiological:
X rays of the spine: show a reduced disc space and loss of definition of the paradiscal margins.
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 .cultures are usually negative. Confirmation of diagnosis is on histopathology.

What is treatment for Tuberculosis of the spine ?
Anti-tuberculous chemotherapy and bed rest and later protective bracing and mobilization form the mainstay of treatment.Operative intervention is required when:
- There is a progressive neurological deficit
- No response to conservative management
- Persistent neurological deficit
- Decompression of large abscesses
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
Tuberculosis of The Spine Tuberculosis of The Spine 08/01/2015
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