A person with tb disease has a large amount of tb bacteria in the body. Pott disease, also known as tuberculous spondylitis, is a classic presentation of extrapulmonary tuberculosis tb. Tb of the spine typically occurs following haematogenous spread of mycobacterium tuberculosis from a primary infection site and is characterised by gradual destruction of one or more spinal. Recognize the causes and symptoms of spinal tuberculosis, so that it can be avoided and not too late to be treated. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Patients of tb spine who received surgery had a better clinical outcome. Multidrugresistant tuberculosis of the spineis it the. Its recovery is a long process and up to 3 months bed rest is advised if all goes well. If the correct drugs are taken for the entire duration of treatment, then they will for most patients provide a cure for tb. The reduction in postoperative re cumbency and hospitalization after resections of the stomach, appen dicectomies and herniectomies is also indicative, although no direct comparison can be made between tuberculosis of the spine and these. It accounts for approximately half of all cases of musculoskeletal tuberculosis. It spreads through blood from the lungs or lymph nodes into the bones, spine, or joints. Most people do not need to be admitted to hospital during treatment.
Neural deficit means weakness in the limbs and in late cases complete loss of motor power and loss of bladder bowel control. Magnetic resonance imaging and gene xpert help in early detection and treatment of spinal tb. Tuberculosis of the spine, or tubercular spondylitis is an inflammatory disease of the spine, a characteristic feature of which is the primary destruction of the vertebral bodies with subsequent deformation of the spine tuberculous spondylitis ranks first among all localizations of osteoarticular tuberculosis, accounting for 5060% of the total number of patients. Patients with spinal tuberculosis excluding sacroiliac and sacrum. Spinal tb usually begins because of the rich vascular supply within the spine and other long bones. We report the first study of multidrugresistant tuberculosis mdrtb in the spine. Introduction described first by sir percival pott in 1779. Tb disease is often diagnosed by microscopic examination of three separate samples of sputum phlegm often collected on different days. Spine tb is a curable condition and all complications can be prevented, provided the disease is diagnosed at an early stage and the patient takes regular supervised course of medications. The diagnosis of tb spine from c3c6 was made confidently on clinicoradiological features. Most of the patients respond to medications though.
In recent studies, the surgery of tb spondylitis may improve quality of life and infection control, especially in patients infected by multidrug resistant strands. Tb treatment drugs, failure, length, relapse tbfacts. Tb does not only occur in the lungs, but can also occur in organs and other body parts. Also, in case of mdr tb, in which patients fail to respond well to multi drugs, it may take longer to recover completely. Pott disease, also known as tuberculous spondylitis, is one of the oldest demonstrated diseases of humankind, having been documented in spinal remains from the iron age in europe and in ancient mummies from egypt and the pacific coast of south america. This condition is of great diagnostic importance due to its link to neurologic deficits and painful spinal deformities. Tuberculosis of the spine symptoms and treatment of. Treatment of abscesses associated with spinal tuberculosis john h. The treatment for normal bone tb may last at least one year and in case of spine tb causing paralysis treatment and recovery time depends if paralysis is mild, moderate or severe. Pdf management of tuberculous infection of the spine. The most common presentation is chronic back pain, for which the diagnosis of stb can be easily overlooked, leading to the development of neurological deficits and osseous deformities of the spine.
The category ii regimen is no longer recommended for patients who require tb retreatment and drug. The who guidelines for treatment of drugsusceptible tuberculosis and patient care 2017 update contains policy recommendations on priority areas in the treatment of drugsusceptible tb and patient care. Treatment can be adjusted when susceptibility information becomes available. The disease is named after percivall pott 17141788, a british surgeon. It can develop when bacteria spread through droplets in. Tuberculosis of spine presentation and treatment bone. The medical management of spinal tuberculosis orthopaedic. The diagnosis tends to be delayed because of a nonspecific initial early manifestations andor low degree of suspicion. Tb treatment for c2 lesion can also be handled via the posterior approach surgery with good results, especially for.
The average prevalence of all forms of tuberculosis in india is estimated to be 5 per thousand skeletal system involvement occurs in 1% to 3% of the patients and up to 50% of these affected patients have tb of the spine differential diagnosis tumours of spine. Spinal tuberculosis is a destructive form of tuberculosis. Because there are less bacteria, treatment for latent tb infection is much easier than treatment for tb disease. In 1782, sir percival pott described spinal tb and surgical treatment of paravertebral abscess. Tuberculosis of the spine is a challenging disease to treat because of the prolonged time of conservative treatment and the technical difficulties of surgical intervention. The current consensus is to diagnose and treat spinal tb early, prevent. The incidence of atypical clinicoradiological presentations of spinal tb is on the rise. Treatment of abscesses associated with spinal tuberculosis. Tuberculosis of the spine potts disease presenting as. The incidence of spinal tuberculosis is increasing in developed nations. Pharmacologic therapy for treatment of spinal tb is generally the same as for pulmonary tb. Treatment modalities for tuberculosis of the spine. Corticosteroids improve the outcome in tuberculosis by suppressing the host mediated inflammation.
Tuberculosis tb is a bacterial infection that can be dangerous, but its almost always curable. At present, the systemic treatment for the tuberculosis of the antituberculosis medications is the first line of treatment. Learn what medications are used for each type of the disease. Spinal tuberculosis or potts disease is an infection of the vertebral column caused by mycobacterium tuberculosis. The aim was to determine the clinical, radiologic, and drug resistance profile as well as the factors associated with treatment outcome of mdrtb in the spine summary of background data. Extrapulmonary tb can present with signs and symptoms related to the affected organ system or as a chronic systemic inflammation, namely with. Although the first documented spinal tuberculosis tb cases date back to 5,000yearold egyptian mummies, the first modern case of spinal tb was described in 1779 by percival pott. Spinal tuberculosis is more common in children and young adults. The spine is the most common site for osseous involvement by.
Improper dosing, inadequate duration of treatment, and inappropriate selection of candidates for chemotherapy has not only resulted in the resurgence of tb but also led to the most dreadful consequence of multidrug resistant strains. How do i present a case of tb spinewith neurological deficit how to examine a spine case how to diagnose tb spine what are the other possible diagnosis how to differentiate from them clinically how they are investigated in your hospital possible options in management how is it managed. Uncomplicated spinal tb has good response to appropriately dosed multimodal. Spinal tuberculosis stb is a common form of extrapulmonary tuberculosis tb, accounting for 3. Spinal involvement occurs in less than 1% of patients with tb 2, 3 but the increasing frequency of tb in both developed and developing countries has continued to make. Bernhard paus treatment for tuberculosis of the spine antituberculosis drugs in conjunction with radical operation and short hospitalization with no. The anterior convexity and forward displacement of tracheal shadow of more than 8 mm from the. Other infectious afflictions of spine like brucella, pyogenic. Spinal tuberculosis treatment options beyond guidelines. As soon as the pott disease is suspected, the patient is placed on bed rest and chemotherapy is indicated. Medical therapy for spinal tb requires a combination of at least 3 antituberculous drugs. Pott disease, or potts disease, is a form of tuberculosis that occurs outside the lungs whereby disease is seen in the vertebrae. Tuberculosis, myelopathy, spinal cord, antituberculous treatment.
If you take your medicine as instructed, it can keep you from developing tb disease. Drug treatment of multidrugresistant osteoarticular tuberculosis. Tuberculosis can affect several tissues outside the lungs including the spine, a kind of tuberculous arthritis of the intervertebral joints. Evolution of treatment preantitubercular era surgery was not attempted due to fear of secondary infection and death most of operative procedures were developed for either for treatment or for prevention of paralysis in tb spine principle was more direct approach to. Medicines and rest are first line of treatment in tuberculosis of spine. Now that drugs are available surgery is rarely used as treatment for tb.
You and your health care provider must decide which treatment is best for you. Tuberculosis of spine spinal tuberculosis manifest. If required, surgical intervention is necessary to prevent. In many countries there will be a cost for tb treatment, even if the tb drugs themselves are free.
Tuberculosis tb is a disease caused by germs that are spread from person to person through. It is associated with significant morbidity and can lead to severe functional impairment. Additional drugs are administered during the first 2 months of therapy. Patients below the age of 15 and with kyphosis above 30. Inh and rifampin should be administered during the whole course of therapy. Treatment for tuberculosis tb usually involves taking antibiotics for several months. Pathophysiology and treatment of spinal tuberculosis. The duration of symptoms of the,illness at the time of presentation in the.
Tb spine needs to be operated if there is a neural deficit which is not responding to medications or is worsening in spite of medications. For the diagnosis of spinal tuberculosis magnetic resonance imaging is more. Meningeal tuberculosis occurs when tuberculosis travels through the bloodstream to the membranes surrounding the brain and spinal cord, called the meninges. The classic destruction of the disk space and the adjacent vertebral bodies, destruction of other spinal elements, severe and progressive kyphosis subsequently became known as potts disease. Surgery is indicated if patient is not responding to conservative treatment. Tuberculosis tb is an infectious disease that usually affects the lungs, though it can affect any organ in the body. Tuberculosis of spine standard treatment guidelines.
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