spinal tuberculosis (pott’s disease)

8/22/2019 Spinal Tuberculosis (Potts Disease)

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Spinal Tuberculosis

(Potts Disease).

Kiking Ritarwan


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Sinonim

Potts disease

Davids disease

Angular kyphosis Kyposis secondary to tuberculosis

Tuberculosis of the spine


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The first found Pervicall Pott (England,1779),triad of potts disease: abscess, gibuss,paraplegia

Single or multiple vertebral involvement bytuberculosis is frequently followed by spinalcord compression due to development of

cold abscess in epidural space (Pottdisease)

The most common site of infection isthoracolumbar spine, rarely cervical spine.


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ANATOMI VERTEBRA

ANATOMI VERTEBRAP ro c . M a

s t o id

A t la s

A x is

P ro c e s s u ss p in o s u s D is k u s In t e r v e r t

C o rp u s v e r tC 7

TH1

T h 1

T h 1 2

L 1S p in a l n e r v e

M a n d ib u laC 1

C 2

P e lv ic C u r v a t u r a

P ro m o n t o r y

D is c I n t e r v e r t

N u k le u s P u l p o s u s

C o rp u sv e r t e b ra

C o rp u s v e r t e b ra

W E IG H T

P

ro c S p in o s u s


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Lokasi

Spondilitis TB

1.Paradiscal type >

2. Central type

3. Anterior type

4. Post Facet joint

5. Appendicial

1

2

4

3

1

5


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Spondilitis Tuberkulosa


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Pathogenese

Begin from existence of primary focus outside vertebra[ extrapulmoner], later;then disseminate by hematogen tovertebra and usually [regarding/ hit] part of corpus vertebraeanterior at elbow intervertebralis discus.

Peaky earn happened just where as long as vertebra, but atmost [at] mid and under thoracalis vertebra and lumbalvertebra.

Can [regarding/ hit] one segment or some vertebra segment.[At] the place can happened cheese that happened effect offorming [of] granulasi network and destruction on corpus

vertebra little by little from anterior to posterior. This Destruksi can generate anguler gibbus. Besides also earn

also happened " Cool abscess [ Cold Abcess]. Most [is] oftenmet [by] cool [by] abscess [at] thorakal vertebra 8 until lumbal 3.


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Patofisiologi Spondilitis Tuberkulosa


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Patofisiologi

Rute Penyebaran ke

Vertebra :

Arteri/hematogen

Vena (batson plexus)

Percontinuitatum


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Clinical manifestasion

Back Pain (79%)

Paraparese (66%)

Kyphosis (52%) Fever (45%)

Sensory disturbances (34%)

Bowel and Bladder dysfunction (31%).


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Manifestasi Klinis

Keadaan Umum

Sakit kronis, demam,

keringat malam, anorexia,

Penurunan berat badan Gejala Lokal

Nyeri lokal atau radikuler

Spasme otot punggung

night cries pada anak

Defisit neurologis

Deformitas


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Manifestasi Klinis

Pemeriksaan Klinis Deformitas, gibbus

Spasme otot

paravertebral

Defisit neurologis


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Diagnostic procedure

Pemeriksaan darah : LED meninggi> 100mm/jam Tuberculin skin test (Purified Protein Derivative/ PPD)

biasanya positif Biopsi kelenjar leher Sputum utk BTA (+) dan kultur Mycobacterium tuberculosa

Radiologi- proses spesifik di paru Thorax foto

- Vertebra : gibbus dan kyphosis

- CT Scan Vertebra : destruksi vertebra, soft tissue calcification,narrow disc space, bone erosion(scalloping).

- MRI vertebra:

a. membedakan TB spondilitis atau pyogenic spondylitis,

b. melihat adanya kompresi saraf.


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Foto Rontgen


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CT Scan


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MRI


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Treatment

1. Immobilisasi, best rest total, extrafeeding, brace, korset 2. Antituberculous drugs

Berdasarkan Pedoman Penatalaksanaan TB paru:

termasuk kategori I ( TB diluar paru):

# 2 bln pertama : Streptomycin, INH, Rif dan PZA

# Bulan 3-12 : INH dan Rifampin

3. Operative

- Indikasi operasi pada potts disease:

adanya defisit neurologis

adanya abses paravertebra [Cold Abses]

terapi konservatif gagal

severe kyposcoliosis

cord/ nerve compression

- Tindakan bedah yang dilakukan:

requires anterior abscess drainage

anterior spinal arthrodesis.

posterior spinal arthrodesis.


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PROGNOSA

Dari 100 penderita ,yang mengalami

disability 2 penderita mengalami

reccurence paraplegia setelah 3 tahun

berobat, 1 penderita akibat granuloma

ekstramedularis dan 1 orang dengan

kifosis yang berat.

Angka mortalitas 20%.

spinal tuberculosis (pott’s disease)

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