Download - Diagnosis of Spine Tuberculosis

DIAGNOSING…TUBERCULOSIS SPINE

By Jagjit Khosla

DIAGNOSIS OF TB SPINE

History

Examination

Investigation

Diagnosis

HISTORY

SYMPTOMS OF TB SPINE

Back PainStiffnessSwelling at back

ParaplegiaDeformity

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SYMPTOMS OF TB SPINE

Constitutional symptoms6

Evening rise of temp Night sweats Weight loss and anorexia

+ Previous history of Pulmonary TB or Contact history

BACK PAIN

Congenital

Traumatic

Inflammatory

Neoplastic

Degenerative

Metabolic

BACK PAIN Not since birth No H/o Trauma/Lifting weight or

strenuous exercises preceding pain No other bone or joint problems Non radiating pain No Morning stiffness No H/o Haematuria, dysurea, oliguria No H/o Menstrual problems

Congenital

Traumatic/ Prolapsed disc

NeoplasticProlapsed disc

Ankylosing spondylitis

Genito-urinary

Gynaecological

EXAMINATION

ON EXAMINATION

• Kyphotic deformity

ON EXAMINATION

Spinal movements restricted

Paravertebral swelling

EXAMINATION Straight Leg raising test

Cough impulse over swelling

Prolapsed disc

Meningocele (spina bifida)

INVESTIGATIONS

INVESTIGATIONS

• X-RAY – AP and Lateral view• MRI• C.T. Scan• Myelography• Biopsy• Ix for Primary focus – Chest X-ray, X-ray KUB• General Investigations

NORMAL VERTEBRAL COLUMN

NORMAL X-RAY SPINE

AP VIEW LATERAL VIEW

X-RAY SPINE IN TB SPINE

REDUCED DISC SPACE

1


DECREASED HEIGHT OF VERTEBRA

2


DESTRUCTION OF

VERTEBRAL BODY

3


COLD ABSCESS

4

Retropharyngeal abscess


COLD ABSCESS

4

Widened mediastinum


COLD ABSCESS

4

Para vertebral Fusiform abscess


COLD ABSCESS

4

Psoas abscess

MRI IN TB SPINE

ABSCESS

1

VERTEBRAL DESTRUCTION

2SPINAL CORD

COMPRESSION

3

CT SCAN IN TB SPINE

EXTENT OF DESTRUCTION1 ABSCESSES2

OTHER INVESTIGATIONS

• Myelography – Level of nerve lesion• Biopsy - Etiology• Chest X-ray• X-ray KUB• General Investigations – – ESR, Mantoux, ELISA

Primary focus of TB

Thank you…