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VITAL SIGN
• BP: 120/80 mmHg
• HR: 80x/mnt, regular
• RR: 20x/mnt,
• T : 36,7 ˚C (axiller)
CLINICAL PICTURE
LOCAL STATUS
Vertebra Region :
I : Kyphotic deformity (+), scar (+),
gibbus as level as Vertebra
Thoracal VII, hematome (-),
eritema (-), swelling (-)
0 0
0 0
0 0
0 0
0 0
yes
2 2 2 2
2 2 2 2
2 2 2 2
2 2 2 2
2 2 2 2
2 2 2 2
2 2 2 2
2 2 2 2
2 2 2 2
2 2 2 2
2 2 2 2
2 2 2 2 Any anal sensation
2 2 2 2 0 → Absent Y
2 2 2 2 1 → Impaired
1 1 1 1 2 → Normal
1 1 1 1 NT → Not testable
1 1 1 1
1 1 1 1
1 1 1 1
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Reflex
Physiologic Reflex Pathologic Reflex
R L R L
• Biceps (+)N (+)N • Babinski (+) (+)
• Triceps (+)N (+)N • Chadock (-) (-)
• Achilles (+) ↑ (+) ↑ • Openheim (+) (+)
• Patellar (+) ↑ (+) ↑ • Hoffman (-) (-)
• Tromner (-) (-)
Laboratory
• RBC : 5,69 x 10^3/µL • CT : 7’00”
• Hb : 15,6 g/dl • BT : 3’00”
• WBC : 18,35 x 10^3/µL Mycotec TB Positive
• PLT : 166 x 10^3/µL ESR : 17/42
• GDS : 114 mg/dl
• Ur/Cr : 48/1.3
• SGOT : 52 U/l
• SGPT : 184 U/l
Radiologic Findings
Thoracolumbal AP & Lateral
Radiologic Findings
Lumbosacral AP & Lateral
Radiologic Findings
CT-Scan Thoracolumbal
MRI Thoracolumbal
Summary
A 35 years old male presented with 4 months
history of cannot move both lower extremity,
appeared suddenly and continually without any
trigerring factor. cramps (+), heavy sensation (+)
at both of lower extremity then become difficult
to walk or even standing. Pain on back (+) suffered
since 6 month, pain feel more intense day by day,
spread to thigh, pain at night (-). Numbness (+) on
both of his legs. There are history of fever (+),
history of loose weight (+), history of night sweat
(+) since 6 month before admittance.
Cont..
On physical exam found Kyphotic deformity (+), scar
(+), gibbus as level as Vertebra Thoracal V. Neurological
deficit at lower motoric which is anastesia at the level
L1 and hipostesia at the level Th 7 downward. There is
an increase of fisiologic reflex at both of leg and
pathologic reflex found at both of leg.
Laboratory findings:
Radiological imaging: (Plain X-Ray)-Destruction of
invertebra disc CV Th. 7 and 8 and also paravertebra
abscess due to a possibility of Spondylitis. (MRI)-
Spondylitis TB at level T7-8 with paravertebra
abscess.
Diagnose
Paraplegia due to Suspect of Tuberculous Spondylitis as
level as Vertebra Thoracal 7th - 8th + paravertebra
abscess
Treatment
• Non operative
• Bed rest
• Anti-tuberculosis drugs
• Adequate nutrition
• Plan for culture bacteria
• Operation
• Debridement/ Evacuation of abcess
Discussion
Anatomy
33 Vertebrae:
7 Cervical (lordosis)
12 Thoracic (kyphosis)
5 Lumbar (lordosis)
5 Sacral fused
(kyphosis)
4 Coccygeal fused
(kyphosis )
Anatomy
Anatomy
Tuberculose
Spondylitis
INTRODUCTION
• Tuberculosis of the spine also known Pott’s
disease.
• Since the advent of antituberculosis drugs and
improved public health measured,
Tuberculosis of the spine has become rare in
industrialised countries, although it is still a
significant cause of disease in developing
cauntries
Definition
• A spinal infection associated with tuberculosis
• Characterized by a sharp angulation of the
spine where tubercle lesions are present.
• Also called Pott's disease.
1 1.Paradiscal type
2. Central type
3. Anterior type
2
Crenshaw AH. Spinal anatomy and surgical approach. In : Campbell’s operative orthopaedics. 8th
Ed. Missouri : Mosby Year Book 1992.p.3493 – 514; 3792 – 817
• The most common form, peridiscal, occurs
adjacent to the vertebral endplate and
spreads around a single intervertebral disc as
the abscess material tracks beneath the
anterior longitudinal ligament.
• Central involvement occurs in the middle of
the vertebral body and eventually leads to
vertebral collapse and kyphotic deformity.
• Anterior infections begin beneath the anterior
longitudinal ligament, causing scalloping of
the anterior vertebral bodies, and extend over
multiple levels.
Pathophysiology
• Spreads via:
– Artery/hematogenous
– Vein (batson plexus)
– Percontinuitatum
Tuli SM. Tuberculosis of the spine. New Delhi : Amerind, 1975 .p. 564 – 7.
Pathophysiology
Tuberculosis Granulomatous
infection inflammation
Weakening of
the trabeculae Disc
of vertebral degeneration
body
Kyphotic
deformity
Tuli SM. Tuberculosis of the spine. New Delhi : Amerind, 1975 .p. 564 – 7.
Affected
vertebra
Vertebral
abscess Collection of pus
and tubercular
debris
Comes out
Anteriorly Posteriorly
Press neural
Form psoas absces
structures in
spinal canal
Tuberculosis of the Musculoskeletal SystemDavid A. Spiegel, M.D.,* Girish K. Singh, M.D., and Ashok K. Banskota, M.D.
Diagnosis
History & Physical
Examination
Laboratory
Investigation
Radiology
History Taking
• Back pain
• Numbness
• Neurological deficit
• History of pulmonary
tuberculosis
Physical Examination
• Deformity
• Tenderness
• Spinal movement are
limited
• Gait
• Neurological deficite
Radiological
• X – Ray
Early sign – local
osteoporosis of two
adjacent vertebra,
Early disease narrowing of intervertebral
– loss of disc disc space
space
Later - bone destruction,
collapse of adjacent
vertebra bodies produce
angular deformity
• CT-Scan and MRI
Investigation of cord
compression
Laboratory finding
Devlin, VJ. Spine Secret Plus, Second ed. Missouri: Mosby Elsevier; 2010
Complications