Post on 06-Apr-2018
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BSPT 4TH
YEARBATCH 2007
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Topics of discussion
Introduction
Epidemology
Symptoms Age
Sex
Race
Frequency
Mortality/Morbidity
Risk factors Spinal Damage
Diagnosis
Treatment
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(TB OF SPINE)
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ALTERNATE NAMES
Pott's syndrome
Pott's caries
Pott's curvature angular kyphosis
kyphosis secondary to tuberculosis
tuberculosis of the spine
tuberculous spondylitis
David's disease
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Tuberculosis (TB) is aninfection that usually
occurs in the lungs(tuberculosis bacillus);but sometimes it
happens in the spine
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DISTRIBUTION
The commonest area affected is T10 to L1.
The lower thoracic region is the mostcommon area of involvement at 40 to 50%,with the lumbar spine in a close second placeat 35 to 45%.
The cervical spine accounts for about 10%.
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EPIDEMIOLOGY
Rare in the UK but in developing countries itrepresents about 2%
Tuberculosis worldwide accounts for 1.7billion infections, and 2 million deaths peryear.
Over 90% of tuberculosis occurs in poorercountries, but a global resurgence is affectingricher ones.
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EPIDEMIOLOGY
India, China, Indonesia, Pakistan andBangladesh have the largest number of cases
The disease affects males more than femalesin a ratio of between 1.5 and 2:1.
In the USA it affects mostly adults but in thecountries where it is commonest it affectsmostly children.
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back pain
Fever
weight loss
loss of appetite
Imbalance
Clumsiness sometimes even paralysis
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Tuberculosis spondylitis often causes damage
to the spine. It can result in the collapse ofvertebrae and fracturing of the bones.Abscesses and tissue formation can narrowthe spinal canal, leading to neurological
damage
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RISK FACTORS
Endemic tuberculosis
Poor socio-economic conditions.
HIV infection
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Blood cp( ESR)
Range of motion in the spine.
A series of neurological tests
complete medical history
blood immunoglobin profile
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X-rays
magnetic resonance images (MRIs)
CT scan guided biopsy
Bone scans
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DIFFERENTIAL
DIAGNOSIS
Pyogenic osteitis of the spine.
Spinal tumours
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X-RAY
Spinal x-ray maynot show earlydisease as 50% ofbone mass must
be lost forchanges to bevisible on x-ray
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MRI
MRI is useful to demonstrate the extent ofspinal compression and can show changes
at an earlier stage than plain radiographs
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CT scans and nuclear bone scans can also beused.
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FUNCTIONAL DEFICIT
Paraparesis , Quadriparesis
Paraplegia , Quadriplegia
Early Onset Paraplegia
Late Onset Paraplegia
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NEUROLOGICAL COMPLICATIONS
OF TUBERCULOSIS OF THE SPINE
Physical compression of the neural tissues
inflammation of these neural tissues(Meningitis / Arachnoiditis / Neuritis )
Fluid retention in the local tissues ( Oedema )
By disturbances of the blood supply to thesedelicate neural tissues ( Vascular thrombosis)
Due to chronic stretching and attrition of theneural tissue
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TREATMENT
Drug treatment
Bed rest
Spinal braces
Surgery
PT treatment
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DRUGS USED IN TUBERCULOSIS
AmikacinCiprofloxacinCycloserine
EthambutolIsoniazid.NorfloxacinOfloxacin
PyrazinamideRifampinSparfloxacinStreptomycin
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BED REST
During the phase of destruction and during
the period of potential complications likedeveloping neurological compression,enforced Bed Restis needed. The duration ofrest varies as per the case and is to be
decided by the treating Physician
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SPINAL BRACES
In a true sense the brace cannot avoid vertical loadingforces on the diseased part
longer the brace better is thecontrol of the spine
more rigid the brace better isthe control
The brace must beappropriately selected,perfectly crafted andproperly used
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SURGERY
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SURGERY The surgery has 3 main aims.
1) Debridement : Removal of diseased tissue(pus, graunulation tissue, sequestra etc. ).
2)Neural Decompression : To relieve the SpinalCord and nerves from the compressive effectsof the disease.
3)Stabilization : Restoring strength and stabilityof the destroyed area by bone grafting (fusion ) and if required by instrumentation (using metalic implants for internal support ofthe spine
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SURGERY
Sometimes the surgery may be needed forcorrection of the spinal deformity and toreduce the effects of growth discrepancyproduced by the disease
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PT TREATMENT
During the period of recumbancy and support
Requiring lengthy immobilization (lower limb
mobilization) Chest physiotherapy (in adult there may be
also risk of respiratory infection andthrombosis)
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PT TREATMENT
Minimization of for
stiffness atrophy (by exercises)pressure sores
positioning
careful bladder training programme
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PT TREATMENT
Massage (maintain circulation and nutritionof tissue
Gentle passive and active movements
Breathing exercises
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PT TREATMENT When healing has been taken place
Treatment plane
Strengthing of patient muscle
Increase mobility in any joint in which it isimpaired in except those in the area attack bythe disease
Low forcible strengthing and mobilization ofspine
Massage it should be given to the limb anddisease area and may be given cautiously
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EXERCISES
ROM of all joints
Active movements done by patient of upper
limb No over stretch over pressure should be given
in any trunk exercises
Thorax need mobilizing with care and nomovement should be undertaken which couldput any strain on spine
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EXERCISES
Especial care is necessory with regard to any
movement to take place most freely in theregion for example specific trunk rotation andturning to the lower thoracic region
Forward flexion should not be done
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BREATHING EXERCISES
Costal diaphragmatic and apical breathing Most freely movements must be given to arm
and leg with simple resistance may be addedbut no over stretch when arm raise above thehead
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GENERAL MEASURES
SKIN CARE:Change posture every 2-4 hrly to avoid bed
sores.
Keep skin dry and clean.BLADDER CARE:CATHETERIZATION for urinary retention.BOWEL CARE:Avoid constipation by suitable diet and
laxatives.
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GENERAL MEASURES
PREVENTION OF CONTRACTURES
By regular passive movements. REHABILITATION
By using wheel chair,standing
frames,vocational training etc.
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CONTRAINDICATIONS
Any form of hanging
Trunk rolling
Exercise with over stretching
Movement with strong resistance by force of
gravity
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PROGNOSIS
The progress is slow and lasts for months oreven years.
Prognosis is better if caught early andmodern regimes of chemotherapy are moreeffective.
A study from London showed that diagnosis
can be difficult and is often late.1
http://www.patient.co.uk/doctor/Pott's-Disease-(Spine).htmhttp://www.patient.co.uk/doctor/Pott's-Disease-(Spine).htm8/2/2019 Pott's Disease by Ali
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USEFUL LINKS FOR
TUBERCULOSIS http://www.who.int/gtb/
http://www.cpmc.columbia.edu/tbcpp/http://www.tuberculosis.net/http://dir.yahoo.com/Health/diseases_and_conditions/tuberculosis/
http://www.medwebplus.com/subject/Tuberculosis
http://www.who.int/gtb/http://www.cpmc.columbia.edu/tbcpp/http://www.tuberculosis.net/http://dir.yahoo.com/Health/diseases_and_conditions/tuberculosis/http://dir.yahoo.com/Health/diseases_and_conditions/tuberculosis/http://www.medwebplus.com/subject/Tuberculosishttp://www.medwebplus.com/subject/Tuberculosishttp://www.medwebplus.com/subject/Tuberculosishttp://www.medwebplus.com/subject/Tuberculosishttp://dir.yahoo.com/Health/diseases_and_conditions/tuberculosis/http://dir.yahoo.com/Health/diseases_and_conditions/tuberculosis/http://www.tuberculosis.net/http://www.cpmc.columbia.edu/tbcpp/http://www.who.int/gtb/http://www.who.int/gtb/http://www.who.int/gtb/8/2/2019 Pott's Disease by Ali
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Dpt. Infection and Tropical Medicine, Sheffield Teaching Hospitals
SUMMARY
TB is a challenging disease for the clinician
Must have microbiology before startingtreatment more rapid lab tests?
Need to encourage compliance
Need for multidisciplinary approach todiagnosis and management and control
Need shorter, better, cheap anti TB regimes
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MOST IMPORTANT
When diagnosed promptly, treatedproperly and adequately, tuberculosis ofthe spine has a good prospect of recovery.Earlier the disease is caught in its course
the better it is !
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GREAT SAYING
I can never try to teach my people i can onlyprovide the condition in which they can learn
Albert Ainstien
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