Tb spine history insidious onset of localised pain in the spine. Tuberculous spondylitis radiology reference article. Spinal tuberculosis, the most common form of skeletal involvement, is increasing in prevalence because of the resurgence of tuberculosis during the past decade in patients with aids, the spread of tuberculosis among the homeless, and the expanding immigrant population. Pott disease, or potts disease, is a form of tuberculosis that occurs outside the lungs whereby disease is seen in the vertebrae. Mtb infects the joints of the spine, causing a form of spinal arthritis. There may be evidences of associatedextraskeletal tuberculosis presence of hoarseness, dysphagia, respiratorystridor or torticollis indicate. Ankit madharia junior resident lata mangeshkar hospital, nagpur 2. Spine deformity kyphosis of some degree occurs in almost every patient. Clumsiness in walking and weakness in lowerlimbs may be present. It is primarily a medical disease and treatment consists of a multidrug regimen for 912 months. Tuberculosis of spine presentation and treatment bone and spine. Thirtyone patients with 33 lesions of spinal tuberculosis c1d4 are reported. Tuberculosis was popularly known as consumption for a long time. Tuberculosis of the spine symptoms and treatment of.
The disease is named after percivall pott 17141788, a british surgeon. A sample size of 61 patients statistically significant and representative deemed of the prevalence of tb spine in the population older than 15. Tuberculosis tb is a disease caused by germs that are spread from person to person through. It is caused by a bacterial microorganism, the tubercle bacillus or mycobacterium tuberculosis. Discovery of the specific infectious agent, the tubercle bacillus mycobacterium tuberculosis, did not occur for several millennia until it was isolated by robert koch in 1882 4. The spine is the most frequent location of musculoskeletal tuberculosis, and commonly related symptoms are back pain and lower limb weaknessparaplegia. Pdf management of tuberculous infection of the spine. For the diagnosis of spinal tuberculosis magnetic resonance imaging is more.
Tuberculosis of the spine also known as kochs spine and tuberculous vertebral osteomyelitis is the commonest form of skeletal tuberculosis and accounts for 88% of chronic vertebral infections. Multidrugresistant tuberculosis of the spineis it the. Multidrug resistant form of tuberculosis of the spine is ill reported in the literature. Aristotle is usually credited as being the first to recognize the contagious nature of the disease. Worldwide tuberculosis is the commonest infectious disease and about 95% of cases occur in developing countries. Apr 29, 20 tb spine history insidious onset of localised pain in the spine. Thirteenth report of the medical research council working party on tuberculosis of the spine. Spinal involvement occurs in less than 1% of patients with tb 2, 3 but the increasing frequency of tb in both developed and developing countries has continued to make.
Spinal tuberculosis is more common in children and young. Spinal tuberculosis stb is an extrapulmonary form of tuberculosis tb caused by mycobacterium tuberculosis mtb, which accounts for around 2% of all tb cases and can lead to spine degeneration. Tuberculous spondylitis, also known as pott disease, refers to vertebral body osteomyelitis and intervertebral diskitis from tuberculosis tb. It constitutes about 50 percent of all cases of bone and joint tb. It can develop when bacteria spread through droplets in the air. Medical research council working party on tuberculosis of the spine a 15year assessment of controlled trials of the management of tuberculosis of the spine in korea and hong kong. The existence of tuberculosis tb in ancient times is evident from the fact. The average prevalence of all forms of tuberculosis in india is estimated to be 5 per thousand skeletal system involvement occurs in 1% to 3% of the patients and up to 50% of these affected patients have tb of the spine differential diagnosis tumours of spine. Although tb can be treated, cured, and can be prevented if persons at risk take certain. About 10% of latent infections progress to active disease which. Spinal tuberculosis is a destructive form of tuberculosis.
Tuberculosis of the cervical spine morb pott cervicalis our. The spine is the most common skeletal site affected, followed by the hip and knee. Archaeological evidence suggests that this disease has been a problem in human populations for thousands of years. Spinal tuberculosis is uncommon in the western world. 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. This condition is of great diagnostic importance due to its link to neurologic deficits and painful spinal deformities. Tuberculosis of spine accounts for 50% of all musculoskeletal tuberculosis. Tuberculosis tb is an infectious disease usually caused by mycobacterium tuberculosis mtb bacteria. Introduction skeletal tuberculosis is common in india vertebral tuberculosis is the commonest form of skeletal tuberculosis 50% dorsal spine most commonly involved mostly seen in first 3 decades. Progressive bone destruction leads to vertebral collapse and kyphosis which is commonest in the thoracic spine.
Tuberculosis of the spine is the most common extrapulmonary form of tuberculosis in the asian subcontinent. First is a classic form of pott disease called as spondylodiscitis and other is called spondylitis without disc involvement. For example, tuberculosis of the spine may give you back pain, and tuberculosis in your kidneys might cause blood in your urine. Tuberculosis begins in the lungs when you inhale air that contains mycobacterium tuberculosis mtb, or the bacteria that causes tb. Spinal tuberculosis accounts for nearly half of all cases of musculoskeletal tuberculosis. Diagnosis of bone tuberculosis is based on medical interviews, physical examinations, to investigations in the form of blood tests, mantoux skin tests see skin reactions injected with a few tb antigens, mri or ct scan of the bones, chest and spine xrays, and biopsy taking partial bone tissue if needed. It begins with a primary focus in the lungs and then spreads through the blood into the vertebrae. Oct 28, 2016 the average prevalence of all forms of tuberculosis in india is estimated to be 5 per thousand skeletal system involvement occurs in 1% to 3% of the patients and up to 50% of these affected patients have tb of the spine differential diagnosis tumours of spine. When tb occurs outside your lungs, signs and symptoms vary according to the organs involved. Tuberculosis is an infection caused by the acidfast bacillus mycobacterium tuberculosis, which can be traced back to neolithic human bones. Potts disease, also known as tuberculosis spondylitis, is a rare infectious disease of the spine which is typically caused by an extraspinal infection. Spinal tuberculosis accounts for almost 50% cases of skeletal tuberculosis.
The disease is more common in developing countries but in the developed countries it is also seen, majority of the patients being immigrants from tb endemic countries. Tb disease is suspected clinically when a person presents with the symptoms mentioned above usually together with. The typical site of involvement is the anterior aspect of the vertebral body adjacent to the subchondral plate and occurs. The existence of tuberculosis tb in ancient times is evident from the fact that it was observed in mummies from egypt and peru 9000 bc and has also been described as yakshama in the oldest indian medical treatises of charaka samhita and sushruta samhita, dating back to and 600 bc, respectively. This can develop into potts disease if the infection spreads from the lungs to the spine. Tuberculosis spine radiological spine at risk signs in. Tuberculosis of spinecontemporary thoughts on current issues. The infection reaches the skeletal system through vascular channels, generally the arteries, as a result of bacillemia, or rarely in the axial skeleton through batsons plexus of veins 1.
Spine tuberculosis is the commonest form of skeletal tuberculosis. Pott disease, also known as tuberculous spondylitis, is a classic presentation of extrapulmonary tuberculosis tb. Tuberculosis of spine presentation and treatment bone. Ts has been reported to accounts for 15% of all tb cases from many reports28. Spinal tuberculosis is a rare form of tuberculosis where the mycobacterium tuberculosis bacteria colonize the spine, leading to damage of the spinal discs and subsequent deformity. Tb disease is suspected clinically when a person presents with the symptoms mentioned above usually together with abnormal findings on a chest xray. Tuberculosis tb is an infectious disease that usually affects the lungs, though it can affect any organ in the body.
Dec 14, 2012 although the reported incidence of this atypical form of spinal tuberculosis is approximately 7% 14, 105, it is estimated that the incidence of this type of spinal tb would be higher if whole spine mri is performed. About 10% of latent infections progress to active disease which, if left untreated, kills about half of those. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Tuberculosis of spine journal of pakistan orthopaedic. The world health organization estimates that in china alone there are 1. It accounts for approximately half of all cases of musculoskeletal tuberculosis.
Controversies and a new challenge was the most popular article and cited a total of 18 times. Magnetic resonance imaging is an excellent imaging modality for the diagnosis of tuberculosis of the spine and can diagnose tuberculosis of the spine four to six months earlier than conventional methods offering the benefits of early detection and treatment. Tuberculosis of the spine, or tubercular spondylitis is an inflammatory disease of the spine, a characteristic feature of which is the primary destruction of the vertebral bodies with subsequent deformation of the spine tuberculous spondylitis ranks first among all localizations of osteoarticular tuberculosis, accounting for 5060% of the total number of patients. Although the first documented spinal tuberculosis tb cases date back to 5,000yearold egyptian mummies, the first modern case of spinal tb was described in 1779 by percival pott. Tuberculosis spine radiological spine at risk signs in the. Tuberculosis of spine standard treatment guidelines. Chapter 2 transmission and pathogenesis of tuberculosis.
A positive result indicates that a person has been infected with the tuberculosis bacteria at some point in his or her life. The success of the changes within the union may well depend on how the programme for the 23rd conference in mexico city is designed and whether it is intended to have a 24th in 1977. Despite the belief that spinal tuberculosis is controlled, some issues of diagnosis and. Tuberculosis of spine spinal tuberculosis manifest. Patients attending orthopaedic out patient department. Tb usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. In some instances, if there is a deformity, it might need to be corrected as well.
Spinal tuberculosis definition of spinal tuberculosis by. Showing incidence of skeletal tuberculosis and that of spinal caries. Tuberculosis encompasses an enormously wide disease spectrum affecting multiple organs and body systems predominantly caused by the organism mycobacterium tuberculosis. Jan 23, 2020 tuberculosis tb is an infectious disease that usually affects the lungs, though it can affect any organ in the body. Surgery in tuberculosis generally involves stabilizing the spine with some kind of rods and screws along with taking off the compression on the neural elements nerves. The current consensus is to diagnose and treat spinal tb early.
Tuberculosis causes three million deaths each year, and 90 million new cases have been diagnosed in the last ten years. A small proportion can also be caused mycobacterium bovis. The distribution of lesions was c1c2 11, c3c6, c7d4 9. The disease in few cases is resistant to the primary antikochs medications and the number of cases detected is on the rise. Aug 08, 2019 pott disease, also known as tuberculous spondylitis, is a classic presentation of extrapulmonary tuberculosis tb. Transmission occurs when a person inhales droplet nuclei containing. Spine tb is most commonly found in the first three decades of life but can occur in any age group. Other infectious afflictions of spine like brucella, pyogenic. The spine is the most common site for osseous involvement by tuberculosis tb. Although tb rates are decreasing in the united states, the disease is becoming more common in many parts of the world. May, 2015 tuberculosis is an infection caused by the acidfast bacillus mycobacterium tuberculosis, which can be traced back to neolithic human bones. It is associated with significant morbidity and can lead to severe functional impairment.
May 04, 2020 tuberculosis tb see the image below, a multisystemic disease with myriad presentations and manifestations, is the most common cause of infectious diseaserelated mortality worldwide. Most infections show no symptoms, in which case it is known as latent tuberculosis. Tuberculosis can also affect other parts of your body, including your kidneys, spine or brain. Tuberculosis can affect several tissues outside the lungs including the spine, a kind of tuberculous arthritis of the intervertebral joints. This is usually accompanied by fever, malaise,anorexia and weight loss. Tuberculosis generally affects the lungs, but can also affect other parts of the body. A sample size of 61 patients statistically significant and representative deemed of the prevalence of tb spine in the population older than 15 years, ages ranging from 16 to 72 years. Tuberculosis of the spine unlike pulmonary tuberculosis, the treatment of tuberculosis of the spine is still based on the insecure foundation of clinical. Abstract involvement of spine in tuberculosis has serious implications if not diagnosed and treated in time. Genetic susceptibility to spinal tuberculosis has recently been demonstrated. Tuberculosis of the cervical spine morb pott cervicalis.
Most of the patients with spinal tuberculosis in developed countries are immigrants from countries where tuberculosis is endemic. The diagnosis tends to be delayed because of a nonspecific initial early manifestations andor low degree of suspicion. Spinal tuberculosis or potts disease is an infection of the vertebral column caused by mycobacterium tuberculosis. Five patients are presented to illustrate the diagnostic pitfalls and prob lems concerned with the diagnosis of spinal tuberculosis. Most infections do not have symptoms, in which case it is known as latent tuberculosis. Potts disease is a combination of osteomyelitis and arthritis which involves multiple vertebrae. Pdf spinal tuberculosis is a destructive form of tuberculosis. Pdf tuberculosis of the spine and spinal cord alvaro.