Tuberculosis Of Spine: Embryology, Clinical features, Investigations, Treatment

Summary

Spinal tuberculosis, also known as Pott's disease, is the most common form of skeletal tuberculosis, affecting both genders across various age groups, but predominantly in the first three decades of life. This condition causes vertebral lesions, which can progress to significant deformities such as kyphosis. It is typically diagnosed through clinical signs, radiological findings, and various tests including biopsies and imaging. Treatment involves a combination of anti-tubercular drugs, surgery, and supportive care. Prognosis is influenced by factors such as age, severity, and the presence of paralysis, with younger patients showing better recovery potential.

Takeaways

• 😀 Spinal tuberculosis, also known as Pott's disease, is the most common form of skeletal tuberculosis, accounting for about 50% of bone and joint tuberculosis cases.
• 😀 It can affect both males and females equally and is most commonly seen in individuals in the first three decades of life.
• 😀 The vertebral column develops from somites, which differentiate into dermatome, myotome, and sclerotome, contributing to vertebra formation.
• 😀 Spinal tuberculosis often affects the lower half of the upper vertebrae or the upper half of the lower vertebrae, leading to early radiological signs like narrowing of the intervertebral disc space.
• 😀 Batson's plexus of veins plays a crucial role in the spread of tuberculosis from the genital-urinary tract and abdomen to the spine due to its lack of valves.
• 😀 Lesions of spinal tuberculosis are most common in the lower thoracic spine, followed by the upper thoracic, cervical, lumbar, and sacral spines.
• 😀 Clinical manifestations of spinal tuberculosis include pain, weight loss, fever, malaise, gibbus deformity (hunched appearance), and cold abscesses.
• 😀 Cold abscesses are a common feature of spinal tuberculosis, resulting from pus accumulation and often leading to painless swelling, sometimes spontaneously draining.
• 😀 The progression of Pott's paraplegia involves muscle weakness, gait problems, incoordination, spasticity, and potentially paralysis, affecting the lower limbs.
• 😀 Treatment for spinal tuberculosis involves both medical (anti-tubercular drugs) and surgical approaches, with surgery indicated in cases of paralysis or severe deformities.

Q & A

What is spinal tuberculosis, also known as Pott's disease?

Spinal tuberculosis, or Pott's disease, is the most common form of skeletal tuberculosis, affecting the vertebral column. It accounts for about 50% of all bone and joint tuberculosis cases, commonly occurring in the first three decades of life.

What is the embryonic origin of the vertebral column and its blood supply?

The vertebral column develops from somites, which are paired cubical masses formed from the primitive mesoderm in the embryo. The blood supply to the vertebral column follows the segmentation of these somites, with segmental arteries supplying the vertebrae.

What role does Batson's plexus of veins play in the spread of tuberculosis to the spine?

Batson's plexus of veins is a venous system that connects the pelvic veins to the internal vertebral venous plexus. It lacks valves, which allows infections to spread easily from the genital urinary tract and abdomen to the vertebral column.

What are the typical radiological signs of spinal tuberculosis?

Radiological signs include narrowing of the intervertebral disc space, destruction of vertebral bodies, cavity formation, and the presence of soft tissue shadows indicating a cold abscess.

What are the common clinical features of spinal tuberculosis?

Common symptoms include dull, progressive pain in the spine, weight loss, fever, malaise, paraspinal muscle spasms, gibbus deformity (hunched spine), tenderness, cold abscess, and a characteristic gait known as aldermanic gait.

How do spinal tuberculosis lesions manifest in different regions of the spine?

Lesions can manifest in various patterns: paradisal (adjacent vertebrae), central (vertebral body), lateral (lateral collapse), anterior (anterior collapse), and posterior (posterior elements affected). There can also be multiple or skipped lesions.

What is a cold abscess in spinal tuberculosis, and where can it form?

A cold abscess is a painless collection of pus that forms near the affected vertebra. It can track to various regions, including the prevertebral fascia, cervical region, axillary area, thoracic and abdominal regions, and even down to the thigh.

What types of kyphosis can result from spinal tuberculosis?

Kyphosis due to spinal tuberculosis can be classified into knuckle kyphosis (affecting two vertebrae), angular kyphosis (affecting three consecutive vertebrae), and round kyphosis (affecting more than three vertebrae).

What are the diagnostic tests used to confirm spinal tuberculosis?

Diagnostic tests include blood tests (e.g., hemoglobin, total count, ESR), X-rays, computed tomography (CT), magnetic resonance imaging (MRI), acid-fast bacillus staining, histopathological examination, and polymerase chain reaction (PCR) testing.

What are the treatment options for spinal tuberculosis?

Treatment involves a combination of medical and surgical approaches. Medical treatment includes anti-tubercular drugs and nutritional support, while surgical options may include drainage of abscesses, costotransversectomy, decompression, and spinal fusion, depending on the severity and presence of neurological involvement.