Spinal tuberculosis is a destructive form of tuberculosis. Department of spine surgery, xiangya hospital of central south university, changsha 48. Spinal tuberculosis is the most common manifestation of extrapulmonary tuberculosis. Despite the efficacy of medical treatment, surgery is indicated to. Spinal tuberculosis or potts disease is an infection of the vertebral column caused by mycobacterium tuberculosis. The mean delay in diagnosis for spinal tuberculosis the time interval between the onset of symptoms and establishment of spinal tuberculosis clinically was 8. Delay in establishing diagnosis and management cause spinal cord compression and spinal deformity. No signs of active tuberculosis were noted clinically. 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. Drug susceptibility testing guided treatment for drug.
Indications for surgery need to be redefined in this context. British infection society guidelines for the diagnosis and. Pdf spinal tuberculosis is a destructive form of tuberculosis. Although referral to an orthopaedic centre was advised, our patient withdrew from followup. The manifestation of spinal tb depends on the severity and duration of the disease, site of the disease. May 05, 2016 how to treat sciatica effective home exercise progression for sciatic nerve pain duration. Antituberculous drugs changed the surgical approach to spinal tuberculosis. Anterior instrumentation for cervical spine tuberculosis. This condition is of great diagnostic importance due to its link to neurologic deficits and painful spinal deformities.
Surgery in spinal tb is directed toward achieving adequate decompression and debridement, maintenance, and reinforcement of stability and halting the progress of deformity or finally correcting the deformity in healed disease. These cases demonstrate the importance of considering spinal tuberculosis in the differential diagnosis of highrisk patients as well as individualizing treatment strategies for each patient. Tuberculosis of the spine also has neurological complications. The surgical management of spinal tuberculosis in children. The disease remains an important public health issue in developing countries, but is also returning in developed countries due to immigration. The indications for surgery in spinal tuberculosis have been controversial, and more so recently, in the era of renewed understanding of the concept of multidrugresistant tuberculosis along with newer modalities of spinal instrumentation. Most infections do not have symptoms, in which case it is known as latent tuberculosis. Dec 14, 2012 the spinal column is involved in less than 1% of all cases of tuberculosis tb. The second case was treated with emergency surgery and the patient regained full neurologic function at followup. Pdf surgical treatment of spinal tuberculosis complicated with.
Most of the patients with spinal tuberculosis in developed countries are immigrants from countries where tuberculosis is endemic. Tuberculosis of the spine symptoms and treatment of. Posterioronly versus combined posterioranterior approaches for. Surgery without instrumentation is the preferred option in developing country like bangladesh.
Jul 23, 2019 the surgical strategy for treating spinal tuberculosis is to thoroughly debride tuberculosis infection lesions, carry out standardized and effective antituberculosis treatment, alleviate the symptoms of nerve compression, promote the recovery of nerve function, correct kyphosis, and rebuild spinal stability. Surgery mensur osman, zeki abdurahman, gashaw messele, yemane ayele, abraham deneke, asrat sime, tariku gelda m. Clinical characteristics of 78 inpatients with spinal. The effects of spinal tuberculosis can be devastating. Local inflammatory complications of spinal tuberculosis. Spinal tb is a very dangerous type of skeletal tb as it can be associated with neurologic deficit due to compression of adjacent neural structures and significant spinal deformity. The first modern description of spinal deformity and paraplegia resulting from spinal tb was described by percival pott in 1779 1. Faridza yaacob md registrar nor akma yusufmd medical officer adibah mokhtar md. However, immigration, an aging population, and the association of spinal tuberculosis with hiv infection can be expected to increase its prevalence. For adolescent spinal tuberculosis, analysis of the causes of the complications and related reasons is seldom studied. It accounts for approximately half of all cases of musculoskeletal tuberculosis.
Moss1 posterior spinal tuberculosis pst is a form of skeletal tuberculosis that selectively involves the vertebral arch. However it is not clear whether spinal tuberculosis requires active disease elsewhere or whether spinal tuberculosis implies that the patient is contagious. Pott disease tuberculous tb spondylitis differential. Spinal tuberculosis with a long duration of paraplegia may still improve after decompression 2 other indications for surgery include severe back pain, marked kyphosis, spinal instability and large abscessesl,s. Since typical tuberculous spondylitis spreads to involve the adjacent. Ragland,1 ibrahim fikry abdelwahab,2 barbara braffman,2 and davids. However, there were limited data to evaluate the trend of spinal tuberculosis research.
Department of spine surgery, hunan provincial peoples hospital, changsha 45. In this paper, 54 adolescent spinal tuberculosis cases that were treated surgically were studied, and the operation method, curative effect, complications, and related reasons were analyzed. Spinal tuberculosis is more common in children and young. This study investigated the data on all cases of potts disease reported in turkey from 1985 to 1996. Spectrum of mr imaging findings in spinal tuberculosis. Spinal tuberculosis definition of spinal tuberculosis by. Although some of these innovative surgical procedures were successful, the outcome was poor due to the fact that surgery was not supplemented with the yet undiscovered antimicrobial agents. Treatment effect, postoperative complications, and their. Spinal tuberculosis is more common in children and young adults.
Kuppusamy mbbs, mrcpi acting director and consultant chest physician aziah ahmad mahayiddin mrcp, fccp consultant chest physician m. Tuberculosis was popularly known as consumption for a long time. Medical research council working party on tuberculosis of the spine, seventh report 1978b a controlled trial of anterior spinal fusion and debridement in the surgical management of tuberculosis of the spine in patients on standard chemotherapy. It can cause destruction, spinal deformity, and paraplegia. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. 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. This study aims to investigate the trend of spinal tuberculosis research and compare the contribution of research from different countries and authors. For the diagnosis of spinal tuberculosis magnetic resonance imaging is more. Pdf surgical management of tuberculosis of the spine.
Spinal tuberculosis is uncommon in the western world. The relative rarity and varied presentations of spinal tuberculosis pose diagnostic difficulty, warranting its inclusion in the differential diagnosis of any spinal disorder. Surgical treatment of selected patients with multilevel contiguous. The most common form of the disease is tuberculosis of the lungs pulmonary consumption, or phthisis, but the intestines, bones and joints, the skin, and the genitourinary, lymphatic, and nervous systems may also be affected. Aug 15, 2012 tuberculosis of skeletal system sm tuli 4th edn spine surgery edward c.
Tuberculosis tb is an infectious disease usually caused by mycobacterium tuberculosis mtb bacteria. Spinal tuberculosis article about spinal tuberculosis by. Despite the efficacy of medical treatment, surgery is indicated to avoid or correct significant deformity, treat spinal instability, prevent neurological compromise, and to eradicate an extensive tuberculous abscess. In recent years, it has been reported that in cases of progressive singlesegment spinal tuberculosis, surgery by a posterior approach can achieve. Despite the efficacy of medical treatment, surgery is indicated to avoid or correct. Surgery may be necessary, especially to drain spinal abscesses or debride bony lesions fully or to stabilize the spine.
The objectives of our study are to assess clinical and xray features of patients with spinal tuberculosis treated at hcfmusp iot s spine group in the last 25 years and to compare conservative treatment alone to the surgical approach combined with antibiotic therapy, especially regarding residual deformity and neurological deficit. The manifestation of spinal tb depends on the severity and dura. Spinal tuberculosis tuberculosis can affect any part of the spinal cord, including the nerve roots, and therefore can present with upper or lower motor neuron involvement, or a mixed clinical picture. Results of nonsurgical treatment of thoracic spinal. Although uncommon, spinal tb still occurs even in both developed and developing countries 2,3. Proper diagnosis and antituberculosis treatment with or without surgery will result in cure. Tuberculosis tb is a common form of osseous tb, accounting for 50%60% of cases.
Surgical intervention in the treatment of spinal tuberculosis tb antedated the discovery of the antibiotics. Clinical presentation of spinal tb the clinical picture of spinal tb is extremely variegated. Demographic, epidemiological and clinical features, imaging findings, treatment methods, and prognosis were summarized and analyzed. Surgical treatment for spinal tuberculosis includes focal tuberculosis debridement, segmental stability reconstruction, neural decompression. Tuberculosis generally affects the lungs, but can also affect other parts of the body. Surgical treatment of thoracolumbar spinal tuberculosisa. An analysis of surgical experience with 61 cases premanand s ramani 1, alok sharma 2, sunil jituri 1, dattatraya p muzumdar 1 1 departments of neuro and spinal surgery, lilavati hospital and research centre, bandra west, mumbai, india 2 lokmanya tilak municipal college and hospital. In patients with established complications of spinal tuberculosis, surgery may. In 1882, the microbiologist robert koch discovered the tubercle bacillus, at a time when one of every seven deaths in europe was caused by tb. Tuberculosis tb of the spine potts disease is both the most common and most dangerous form of tb infection. Surgical management of spinal tuberculosis springerlink.
Aug 08, 2019 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. Tuberculosis can be responsible for extensive spinal lesions. The aim of this study was to investigate the efficacy and safety of treatment with a combination of surgery and individual chemotherapy guided by drug susceptibility. Treatment of spinal tuberculosis by debridement, interbody fusion. Spinal tuberculosis synonyms, spinal tuberculosis pronunciation, spinal tuberculosis translation, english dictionary definition of spinal tuberculosis.
The surgical management of spinal tuberculosis in children and adolescents c reid mbchbpret registrar rn dunn mbchbuct, mmedorth, fcsorthsa consultant spine and orthopaedic surgeon, head of spine services groote schuur hospital and red cross war memorial childrens hospital, division of orthopaedic surgery, university of cape town. Patients below the age of 15 and with kyphosis above 30. Cureus challenges in the diagnosis and management of spinal. However, there have been few reports on the topic of drugresistant spinal tuberculosis. Spinal tuberculosis is a secondary infection, which generally occurs via hematogenous spread. How to treat sciatica effective home exercise progression for sciatic nerve pain duration. Spinal tb usually is insidious in onset and the disease progresses at a slow pace. Spinal tuberculosis is the most common form of skeletal tuberculosis. Spinal tuberculosis stb is a common form of extrapulmonary tuberculosis tb, accounting for 3. Gobeze, mekdim tadesse, yimaj abdulwahib debub university, haramaya university, university of gondar, jimma university in collaboration with the ethiopia public health training initiative, the carter center. The incidence of spinal tuberculosis is increasing in developed nations. Therefore, this study aims to study the effect of endobronchial blocker and doublelumen endobronchial tube on onelung ventilation in thoracic spinal tuberculosis surgery a common operation in thoracic sur.
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