TUBERCULOSIS OF SPINE

Information about TUBERCULOSIS OF SPINE

Published on August 7, 2013

Author: drmkreddy78

Source: authorstream.com

Content

Corbel: Dr.N.Somasekhar Reddy M.S.Ortho ., MCh Orth (Liverpool) Sr.Consultant Orthopaedic surgeon , Dr.A.Mohan krishna M.S.Ortho ., MCh Orth (U.K) Consultant Orthopaedic surgeon, Wingdings 2: 2 Wingdings 3: Hameatogenous spread PowerPoint Presentation: Granuloma formation Tissue necrosis & inflammatory response Paraspinal Abscess Localized Track along tissue planes Progressive necrosis of vertebral body- Kyphotic deformity Adjacent vertebral bodies under the longitudinal ligaments Along the fascial planes Ex: Psoas abscess PowerPoint Presentation: Psoas abscess PowerPoint Presentation: Compressive Early onset Paraplegia ACTIVE With in 2 years Late onset paraplegia HEALED After 2 years Tubercular granulation tissue, Sequestra, abscess, Caseous tissue Stretching of cord, Myelomalacia, Internal gibbus, PowerPoint Presentation: Depends on the severity of involvement of long tracts PowerPoint Presentation: A Complete paralysis No motor or sensory function preserved below lesion B   Sensory function only below the injury level Preservation of any demonstrated sensation only C Incomplete motor function below injury level Preservation of motor capacity (Nonfunctional) sensations may or may not be present D  Fair to good motor function below injury level Preservation of useful motor capacity Normal function Complete return of motor and sensory modalities/ reflexes may be abnormal. PowerPoint Presentation: Cold abscess / sinuses Constitutional symptoms: fever, wt loss, night cries (Children) Back pain is earliest & common symptom Weakness paraplegia PowerPoint Presentation: > 50% of bone destruction before seen radiologicall y Classic Radiological triad Primary Vertebral lesion Disc space narrowing Paravertebral abscess Typical tubercular spondylitic features in long standing paraspinal abscesses Aneurysmal phenomenon Fusiform paraspinal soft tissue shadow Skip lesions 7-10% PowerPoint Presentation: CT or USG guided aspiration : HPE / Microbiology / Culture PowerPoint Presentation: 3(HRZE) / 3(HRZS) + 3(HRZ)+12(HR) Paediatric age group, streptomycin (for 2 months) replaces ethambutol to avoid optic neuropathy 4(HRZE) + 14(HR) PowerPoint Presentation: SURGERY INDICATIONS Decompression (+/- Fusion) Advance disease, failure to respond to conservative therapy Debridement +/- decompression +/- fusion Recurrence of disease or of neural complication Anterior transposition of cord ( extrapleural anterolateral approach) Severe Kyphosis (>60 deg) + neural deficits . laminectomy Extradural granuloma / tuberculoma / Old healed disease presenting as secondary canal stenosis / posterior spinal disease. PowerPoint Presentation: Thank you

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