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DiagnosingTuberculosis SpineBy Jagjit Khosla

Diagnosis of TB spineHistoryExaminationInvestigationDiagnosis

History

Symptoms of tb spine

Back PainStiffnessSwelling at backParaplegiaDeformity12345

Symptoms of tb spineConstitutional symptoms6

Evening rise of tempNight sweatsWeight loss and anorexia+ Previous history of Pulmonary TB or Contact history

Back Pain

Back painNot since birthNo H/o Trauma/Lifting weight or strenuous exercises preceding painNo other bone or joint problemsNon radiating painNo Morning stiffnessNo H/o Haematuria, dysurea, oliguriaNo H/o Menstrual problems

CongenitalTraumatic/ Prolapsed discNeoplasticProlapsed discAnkylosing spondylitisGenito-urinaryGynaecological

Examination

On examinationKyphotic deformity

On examination

Spinal movements restrictedParavertebral swelling

examinationStraight Leg raising test

Cough impulse over swelling

Prolapsed discMeningocele (spina bifida)

INVESTIGATIONS

investigationsX-RAY AP and Lateral viewMRIC.T. ScanMyelographyBiopsyIx for Primary focus Chest X-ray, X-ray KUBGeneral Investigations

Normal Vertebral column

Normal X-ray spine

AP VIEWLateral view

X-ray spine in tb spine

Reduced disc space1

Earliest signLateral xrayWell preserved in secondaries, other spine diseases16

X-ray spine in tb spine

Decreased height of vertebra2

X-ray spine in tb spine

destruction of vertebral body3

X-ray spine in tb spine

destruction of vertebral body3

X-ray spine in tb spineCold abscess4

Retropharyngeal abscess

X-ray spine in tb spineCold abscess4

Widened mediastinum

X-ray spine in tb spineCold abscess4

Para vertebral Fusiform abscess

X-ray spine in tb spineCold abscess4

Psoas abscess

MRI in tb spine

Abscess1Vertebral destruction2Spinal cord compression3

Ct scan in tb spine

Extent of destruction1abscesses2

Other investigationsMyelography Level of nerve lesionBiopsy - EtiologyChest X-rayX-ray KUBGeneral Investigations ESR, Mantoux, ELISA

Primary focus of TB

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