CARIES SPINE TANZILA ZAHID

AZKA FAYYAZ
CARIES SPINE:
Pott’s Disease, also known as tuberculosis spondylitis, is a rare infectious disease
of the spine which is typically caused by an extraspinal infection.
Pott’s Disease is a combination of osteomyelitis and arthritis which involves
multiple vertebrae.
The typical site of involvement is the anterior aspect of the vertebral body adjacent
to the subchondral plate and occurs most frequently in the lower thoracic vertebrae.
ETIOLOGY

Pott’s disease is caused when the vertebrae become soft and

collapse as the result of osteitis. Typically, this is caused by
mycobacterium tuberculosis. As a result, a person with Pott’s
disease often develops kyphosis, which results in a hunchback.
CHARACTERISTICS/CLINICAL PRESENTATION
Spinal Involvement
Lower thoracic vertebrae is the most common area of
involvement (40-50%), followed by the Lumbar spine (35-
45%)
Approximately 10% of Pott's disease cases involve the
cervical spine.
The atlanto-axial region may also be involved in less than
1% of cases
THE FOUR PRIMARY PATTERNS OF INVOLVEMENT IN
ADULTS ARE AS FOLLOWS:
1. Paradiscal
• Most common, comprising 50% of all
cases
• Primary focus of infection in the
vertebral metaphysis
• The granuloma erodes the cartilaginous
endplate and narrows the disc space
3. Central Lesions
Involves entire vertebral body
• 2-3 vertebrae are often affected
• Results in significant deformities and
pathological fractures
2. Anterior Granuloma
• Granulomas develop underneath the
anterior longitudinal ligament
• Less bony destruction but increased
bone devascularization
• Further development of abscess,
necrosis and deformity
4. . Appendiceal Type Lesions
Lamina, pedicles, articular
facets and spinous processes
• Initial expansion followed by rupture
and failure
PHYSICAL FINDINGS

Localized Tenderness
Muscle Spasms
Restricted Spinal Motion
Spinal Deformity
Neurological Deficits
NEUROLOGICAL SIGNS

Paraplegia
Paresis
Impaired sensation
Nerve root pain
Cauda equina syndrome
SPINAL DEFORMITIES
A possible effect of this disease is vertebral collapse
and when this occurs anteriorly, anterior wedging
results, leading to kyphotic deformity of the spine.
Other possible effects can include compression
fractures, spinal deformities and neurological insults,
including paraplegia
Back Pain
Back pain is the earliest and most common symptom.
Patients with Pott’s disease usually experience back
pain for weeks before seeking treatment and the pain
caused by spinal TB can present as spinal or radicular.
There is an average increase in kyphosis of 15 degrees in all patients treated
conservatively, and a deformity greater than 60 degrees may develop in 3% to 5% of
patients.
The progression of deformity occurs in two separate phases:
Active phase of the disease (phase-I)
After healing of the lesion (phase-II)
Severity of the kyphosis angle before treatment, level of lesion, and patient’s age
affect the deformity progression.
In general, adults have an increase of less than 30 degrees during the active phase
with no additional change while children can experience considerable changes even
after healing the TB lesion. The severe spinal deformity in children is likely due to
the cartilaginous nature of their bone.
CONSTITUTIONAL SYMPTOMS

Fever Night Weight Malaise

sweats loss
DIAGNOSTIC TESTS

The Mantoux Test (Tuberculin Skin Test)

Injection of a purified protein derivative (PPD)
Erythrocyte Sedimentation Rate (ESR)
ESR may be markedly elevated (>100 mm/h)
Microbiology Studies
Bone tissue or abscess samples are obtained to stain for acid-fast bacilli
(AFB), and organisms are isolated for culture and susceptibility.
RADIOGRAPHY
The following are radiographic changes characteristics of spinal
tuberculosis on plain radiography:
Lytic destruction of anterior portion of vertebral body and Increased
anterior wedging and Collapse of vertebral body
Reactive sclerosis on a progressive lytic process
Enlarged psoas shadow with or without calcification
Vertebral end plates may be osteoporotic
Intervertebral discs may be shrunk or destroyed
Fusiform paravertebral shadows suggest abscess formation
CT Scanning
CT scanning provides much better bony detail of irregular lytic lesions, sclerosis,
disc collapse, and disruption of bone circumference.

MRI
MRI is the criterion gold standard for evaluating disc-space infection and
osteomyelitis of the spine and is most effective for demonstrating the extension of
disease into soft tissue and the spread of tuberculous debris under the anterior and
posterior longitudinal ligaments. MRI is also called the most effective imaging study
for demonstrating neural compression.
Biopsy
Percutaneous CT-guided needle biopsy of bone lesions can be used to obtain tissue
samples. This is a safe procedure that also allows therapeutic drainage of large
paraspinal abscesses.

Polymerase Chain Reaction (PCR)

PCR techniques amplify species-specific DNA sequences which is able to rapidly
detect and diagnose several strains of mycobacterium without the need for prolonged
culture. They have also been used to identify discrete genetic mutations in DNA
sequences associated with drug resistance.
TREATMENT GOALS

Confirm Diagnosis
Eradicate Infection
Identify and Remove Causative Pathogen
Recover/Maintain Neurological Function
Recover/Maintain Mechanical Spine Stability
Correct or Prevent Spinal Deformity
Functional Return to Activities of Daily Living
TREATMENT TECHNIQUES

Anti-Tuberculosis Chemotherapy
Surgical Drainage of Abscess
Surgical Spinal Cord Decompression
Surgical Spinal Fusion
Spinal Immobilization
Physical therapy
ORTHOTIC MANAGEMENT:
SPINAL BRACES
C1-C7 FOUR POST COLLAR

TAYLOR BRACE WITH CERVICAL COLLAR,

D1-D3
SOMI

D4-L2 TAYLOR BRACE, JEWETTE BRACE

L3-L5 GOLDTHWAITE BRACE

FOUR POST COLLAR
The four poster collar comprises of a rigid brace with four upright rods to support
the neck and also to reduce motion; it has chin and occipital supports.
It Is Recommended For Support And Immobilization.
•To the fractured mid or lower cervical spine during the pre & post operative
conditions.
•Pott’s cervical spine
•Cancer cervical spine
•Fracture cervical spine without Neurological deficit
SOMI
•Sternal occipital mandibular immobilizer
•Controls flexion, extension, lateral and rotational movement from C2 to C5
•Immobilizes head in practitioner specified position
•Removable chin support
•Allows patient to lie flat
•Easy to fit in supine position
Indications:
•Caries spine
•C4/5–T3/4 stable fractures, post-operative stabilization
TAYLOR BRACE
Taylor Brace is a spinal brace.
Light in weight
The Taylor brace wraps all dorsal, lumbar and sacral
vertebrae.
Taylor brace supports and immobilizes the spine in neutral
position, still permitting the requisite motion of the
complete body.
The Taylor brace is designed to control the upper
and lower regions of the spinal column and support
spine whilst standing, sitting and walking.
 Taylor brace also offers a safe, non invasive way to
prevent future problems or to help heal from a current
condition.
Indication: caries spine
JEWETTE BRACE
Hyperextension brace with 3 support points:
•Sternal
•Dorsolumbar
• Suprapubic
Give support to thoracic and lumbar spine by preventing twisting and flexion
(bending forward).
 Indications: caries spine, compression fractures, spondyloarthritis, Medium-term
immobilisation after intervertebral disc surgery. Stable vertebral fractures of the
lower dorsal spine and lumbar spine. Post-surgical care after decompression spine
surgery with or without internal fixation.
GOLDTHWAITE BRACE
Lumber corset
When disease involves below L3 region, this brace is used which provides adequate
immobilization at lumbosacral region in caries spine.
REFERENCES:
http://www.physiotherapyindia.in/products-services/orthopedic-support-
items/braces/3130-taylor-brace.html
Tuberculosis of Spine by S. M. Tuli, T. P. Srivastava, B. P. Varma & G. P. Sinha
https://www.physio-pedia.com/Pott%27s_Disease
THANK YOU