pott's disease by ali

8/2/2019 Pott's Disease by Ali

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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).htm


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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/


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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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pott's disease by ali

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