Pott disease ( Spondilitis Tubercolosis) merupakan penyakit manusia tertua.

Ditemukan dari jaman Batu, mummi Mesir kuno dan Peru. In 1779, Percivall Pott, pemberi nama penyakit ini, menjelaskan perjalanan penyakit ini.

Asal Potts desease: secundair karena osteomyelitis dan Arthritis TB

Bisa Lebih 2 vertebrae . Melibatkan bagian anterior dari Corpus Vertebrae ..discus vertebralis Rusak.
Pada orang dewasa discus rusak akibat infeksi dari VB Pada anak2, Lesi primer bisa di Discus Inter vertebralis.

Kerusakan CV yang progresive menyebabkan CV kolaps dan menyebakan kyphosis. Saluran Spinal menyempit ok abses, jaringan granulasi .. Menekan spinal cord==== defisit Neurologi. Terutama bagian thorakal=== lebih kyphotic. Cold absces== infeksi menyebar ke ligament dan soft tisue. Abscesses di lumbar==turun ke bawah ke Psoas === trigonum femoral === ke kulit.

@ Pott disease penyakit musculo skeletal yang paling berbahaya. Karena menyebakan kerusakan tulang, deformitas dan paraplegi.

Thoracic and lumbosacral spine.== Lower thoracic vertebrae (40-50%), the lumbar spine (35-45%). Cervical spine 10%

The presentation of Pott disease depends on the following:

Stadium penyakit Lokasi Kelainan Adanya komplikasi seperti neurologic deficits, abscesses, or sinus tracts

Dilaporkan rata2 : Durasi simptom sampai diagnosis > 4 bulan. Sakit Pinggang yang lama, gejala awal yang paling umum Bisa Spinal dan Radicular

Demam dan Berat Badan Turun Neurologic abnormalities : 50% of cases Kompresi spinal cord diikuti paraplegia, paresis, impaired sensation, nerve root pain, and/or cauda equina syndrome. Spondilitis TBC di cervical Jarang tapi serius komplikasinya,
Pain and stiffness. Patients with lower cervical spine disease can present with dysphagia or stridor. Symptoms can also include torticollis and hoarseness, neurologic deficits.

Lab Studies Tuberculin skin test (purified protein derivative [PPD]) results are positive in 8495% LED Microbiology studies CT-guided procedures

Radiography

Lytic destruction of anterior portion of vertebral body Collapse of vertebral body Reactive sclerosis on a progressive lytic process Enlarged psoas shadow with or without calcification

 Additional radiographic findings may include the following:

Vertebral end plates are osteoporotic. Intervertebral disks may be destroyed. Vertebral bodies show variable degrees of destruction. Fusiform paravertebral shadows suggest abscess formation. Bone lesions may occur at more than one level.

 CT scanning provides much better bony detail of irregular lytic lesions, sclerosis, disk collapse, and disruption of bone circumference. Low-contrast resolution provides a better assessment of soft tissue, particularly in epidural and paraspinal areas. CT scanning reveals early lesions and is more effective for defining the shape and calcification of soft-tissue abscesses. In contrast to pyogenic disease, calcification is common in tuberculous lesions.

 MRI is the criterion standard for evaluating diskspace infection and osteomyelitis of the spine and cold Abcess. MRI ==== Lihat neural compression.15, 1

MRI findings useful to differentiate tuberculous spondylitis from pyogenic

Pott disease : Prolonged bed rest or a body cast. Pott disease carried a mortality rate of 20%, and relapse was common (30%)==before OAT Thoracolumbar spine should be treated with combination chemotherapy for 6-9 months.19 Many experts still recommend chemotherapy for 9-12 months.

4-drug regimen Isoniazid and Rifampin (9-12 bln) Tambahan first 2 months (first-line drugs), pyrazinamide, ethambutol, and streptomycin.
The use of second-line drugs is indicated in cases of drug resistance (cyprofloksasin)

TREATMENT 1.Kemoterapi dan konservative 2.Kemoterapi dan Operasi

 Neurologic deficit (acute neurologic deterioration, paraparesis, paraplegia) Spinal deformity with instability or pain No response to medical therapy (continuing progression of kyphosis or instability) Large paraspinal abscess Nondiagnostic percutaneous needle biopsy sample

Anterior radical focal debridement and posterior stabilization with instrumentation.24,

10

Involves the cervical spine, the following factors justify early surgical intervention:
High frequency and severity of neurologic deficits Severe abscess compression that may induce dysphagia or asphyxia Instability of the cervical spine

Orthopedic surgeons Neurosurgeons Rehabilitation teams

A 3-drug regimen usually includes isoniazid, rifampin, and pyrazinamide. The use of second-line drugs is indicated in cases of drug resistance.
Lama Pengobatan 9-12

Abscess Spine deformities Neurologic deficits and paraplegia

Therapy compliance and drug resistance are additional factors that significantly affect individual outcomes. Paraplegia : responds well to chemotherapy. If medical therapy does not result in rapid improvement, operative decompression will greatly increase the recovery rate. Paraplegia can manifest or persist during healing because of permanent spinal cord damage.