Tuberculosis of the spine

(pott’s disease) most

commonly involves the
thoracic and lumbar
vertebrae and usually
comprises both tuberculous
osteomyelitis and tuberculous
arthritis.
The inflection often begins in the
anterior part of the vertebral body
and extends into the intervertebral
discs.
The tuberculous destruction and collapse
of the vertebral bodies and discs results in
serious deformities (kyphosis and
kyphoscoliosis) of the spine. The kyphotic
angulation, along with the inflammation
and edema of the dura caused by vertebral
collapse, may compressed the spinal cord
and nerve roots, resulting in pain, muscles
spasm and weakness and paralysis.
The tuberculous exudate emerging from a
bone or joint may spread through sinuses in
soft tissues or dissect along fascial planes and
muscle sheaths and present at a more remote
site as a “cold” abscess, so-called because
there is a milder degree of heat compared to
pyogenic abscess and few, if any, acute
inflammatory cells. In this way, tuberculous
exudation from the thoracolumbar spine may
spread along paravertebral muscles and
psoas muscles sheath and localize in the
inguinal region (psoas abscess).
Sign and symptoms

Back Pain
Fever
Night Sweating
Anorexia
Spinal mass, sometimes associated with
numbness, paraesthesia, or muscle weakness of
the legs
 Late Complication

Vertebral collapse resulting in kyphosis

Spinal cord compression
Sinus Formation
Paraplegia (so called Pott’s paraplegia)
 Physical Diagnosis

Usually present with 4 mos to 3year history of low

back pain wit or without associated neurologic
deficits
Sign of nearly abscess or fistula may be present
Only 20% present with contaminated TB lung
infection
Routine lab test and the Mantoux skin test are of
little diagnostic aid
 Diagnostic

Blood test
Tuberculosis skin test
Bone scan
CT of the spine
Bone biopsy and culture (with AFB smear)
Radiographs of the spine
 Treatment
Treat with a four drug regimen for six to
twelve months
Common antibiotics are
 RIFAMPIN
 ISONIAZID
PYRAZINAMIDE
ETHAMBUTOL
 ANTI-TB DRUGS

FIRST LINE THERAPY

Ethambutol
Isoniazid
Pyrazinamide
rifampicid
SECOND LINE THERAPY

AMINOGLYCOSIDES
(E.G AMIKACIN,KANAMYCIN)
POLYPEPTIDES
(E.G CAPREOMYCIN,VIOMYCIN,ENVIOMYCIN)
FLUOROQUINOLONES
(E.G
CIPROFLOXACIN,LEVOFLOXACIN,MOXIFLOXACIN)
THIOMIDES
(E.G ETHIONAMIDE, PROTHIONAMIDE)
THIRD LINE THERAPY

Rifabutin
Macrolides
Linezolid
Thioacetazone
Arginine
 Surgical Intervention

Loosely defined by neurologic deficits,

spinal kyphosis or failure of medical
therapy
Surgical debridement, abscess drainage,
and/or vertebral fusion in additional to
antio-biotics
 Prevention
Controlling the spread of tuberculosis
infection can prevent tuberculosis spondylitis
and arthritis
Patient who have a positive PPD test (but not
active tuberculosis) may decrease their risk b
properly taking medicines to prevent
tuberculosis