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    Spondylitis TB

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    Yohana Koli
    Tuberculosis is one of the most common problem in the developing countries Indonesia is in the 3rd place for the most TB contributing country after India & China 583.000 cases per year Almost of all the patient is in the range of productive age ( 15 – 54 years old ) Epidemiology Vertebrae is the 2nd common place for infected organ by Mycobacterium Tuberculosis ( 50% ) 15% of all extra pulmonary TB cases Male > female & Children > adults The most common site ; thoraco-lumbar , thoracal, lumbar, and cervical

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    Spondylitis TB

    Uploaded by

    Yohana Koli
    62 views33 pages
    Tuberculosis is one of the most common problem in the developing countries Indonesia is in the 3rd place for the most TB contributing country after India & China 583.000 cases per year Almost of all the patient is in the range of productive age ( 15 – 54 years old ) Epidemiology Vertebrae is the 2nd common place for infected organ by Mycobacterium Tuberculosis ( 50% ) 15% of all extra pulmonary TB cases Male > female & Children > adults The most common site ; thoraco-lumbar , thoracal, lumbar, and cervical

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    Tuberculosis is one of the most common problem in the developing countries Indonesia is in the 3rd place for the most TB contributing country after India & China 583.000 cases per year Almost of all the patient is in the range of productive age ( 15 – 54 years old ) Epidemiology Vertebrae is the 2nd common place for infected organ by Mycobacterium Tuberculosis ( 50% ) 15% of all extra pulmonary TB cases Male > female & Children > adults The most common site ; thoraco-lumbar , thoracal, lumbar, and cervical

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    62 views33 pages

    Spondylitis TB

    Uploaded by

    Yohana Koli
    Tuberculosis is one of the most common problem in the developing countries Indonesia is in the 3rd place for the most TB contributing country after India & China 583.000 cases per year Almost of all the patient is in the range of productive age ( 15 – 54 years old ) Epidemiology Vertebrae is the 2nd common place for infected organ by Mycobacterium Tuberculosis ( 50% ) 15% of all extra pulmonary TB cases Male > female & Children > adults The most common site ; thoraco-lumbar , thoracal, lumbar, and cervical

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    of 33

    dr.

    Jainal Arifin, Mkes, SpOT

    SPONDYLITIS TB
    Epidemiology
    Tuberculosis is one of the most common
    problem in the developing countries
    Indonesia is in the 3rd place for the most
    TB contributing country after India &
    China
    583.000 cases per year
    Almost of all the patient is in the range
    of productive age ( 15 54 years old )
    Epidemiology

    Vertebrae is the 2nd common place for


    infected organ by Mycobacterium
    Tuberculosis ( 50% )
    15% of all extra pulmonary TB cases
    Male > female & Children > adults
    The most common site ; thoraco-
    lumbar , thoracal, lumbar, and
    cervical
    Pathogenesis
    Primary tuberculosis :
    In a non immunized individual children*
    adult*
    Deep inhalation of airborne droplet
    Spondylitits TB :
    Secondarily focus infection from the other
    organ via blood transmission ( hematogen )
    Small tubercel ( superior or inferior-anterior
    site of subchondral vertebrae body )
    activate Chaperonin 10 high stimulator of
    bone resorption destruction of anterior
    part of vertebrae body khypose
    respiratory problem & paraplegia
    Pathogenesis
    Primary tuberculosis :
    In a non immunized individual children*
    adult*
    Deep inhalation of airborne droplet
    Pathogenesis
    Spondylitits TB :
    Secondarily focus infection from the
    other organ via blood transmission (
    hematogen )
    Small tubercel ( superior or inferior-
    anterior site of subchondral vertebrae
    body ) destruction of anterior part of
    vertebrae body khypose
    respiratory problem & paraplegia
    Pathogenesis

    Granulomatous reaction blocking


    bone formation relatively avascular
    sequester
    Reach the soft tissue paravertebrae
    abscess following the fascia of
    psoas muscle psoas abscess ( cold
    abscess )
    Narrowing of adjacent disc ( being
    avascular )
    Clinical Appearance
    Systemic symptoms ( fever,
    malaise, night sweat, loss of body
    weight )
    Back pain ( chronic, local or
    radicular )
    Back stiffness
    back color
    Bone alignment
    Mass or gibbus
    Tenderness
    Bone structural & muscle spasm
    Neurological deficit
    Limited range of movement
    Laboratory Findings

    Leukocyte >>>
    ESR is prolonged, >100 mm/h
    CRP (C-reactive protein )
    PCR ( polymerase chain reaction )
    Tuberculin test ( Mantoux )
    Immunology Test

    Intradermal tuberculin
    test ( Mantoux )

    67,5 87,5 % positive

    Sub cutaneous
    Weal formation
    Read after 72 hours.
    5-10-15mm (non-ende)
    Biopsy

    Identification basil
    tuberkel definitive
    diagnosis acid stain,
    fluorokrome and Ziehl-
    Nielsen or culture
    Plain Radiographs

    Affected vertebrae
    ( segment & number )
    Bone destruction rate
    Khypose angle
    Anterior part destruction
    Narrowing of adjacent
    discs
    Plain Radiographs

    Paravertebrae abscess
    (fusiform shadow )
    MRI :

    Central necrosis
    (abscess)
    Inhomogen appearance

    16
    Spinal TB - Potts Disease
    Histo - pathology

    Granuloma and
    caseous appearance,
    Consists central zone
    granular and
    acidophilic which is
    circled by the
    epitheloid cell and
    Langhans giant cell
    with cluster of
    lymphosit at the outer
    margin of the
    granuloma.
    Tuberculous Granuloma
    Treatment

    Improve general condition


    Supportive therapy
    TB Drug
    Surgery
    Treatment

    The aim : eradicate the infection, stabilize the


    vertebrae & to correct the khypose
    The combination of chemotherapy or surgical
    therapy
    INH ( 5-15mg/KgBW/ day ) orally
    Rifampicin ( 10-15mg/KgBW/day ) orally
    Pirazinamid ( 25-35/KgBW/day ) orally
    Ethambutol ( 15-20mg/KgBW/day ) orally
    Streptomycin ( 15-30mg/KgBW/day ) IV
    Treatment

    Surgery :
    To drain abcses, debride sequester
    In spine : to decompress, to stabilize
    Large psoas abces retroperitoneal approach.
    Simple deb. without fussion 90 % fusion at 10 ys
    Hongkong procedure > superior 97 % fusion
    Surgical Therapy

    The indications :
    Significant neurological deficit
    Cervical segment abscess
    Posterior lesion with abscess or sinus
    Vertebrae instability / progressive khypose
    Failed of chemotherapy treatment in 3 6
    months
    Recurrence infection
    Surgery Techniques

    Hongkong Methods ( anterior debridement & strut


    grafting )
    Anterior fusion ( Upadhay et al )
    Anterior instrumentation & strut graft ( Yilmaz )
    Anterior bone graft & posterior osteotomy &
    arthrodesis
    Anterior approach
    Posterior approach
    Costotransversectomy approach
    T E R I M A K A S I H

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