Tuberculosis of spine
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Dr.A.Mohan krishnaM.S.Ortho., MCh Orth (U.K)
Consultant Orthopaedic surgeon,
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Hameatogenous spread
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Granuloma formationTissue necrosis & inflammatory response
Paraspinal Abscess
Localized Track along tissue planes
Progressive necrosis of vertebral body-Kyphotic deformity
Adjacent vertebral bodies under the longitudinal ligaments
Along the fascial planes Ex: Psoas abscess
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Compressive
Early onset Paraplegia ACTIVE With in 2 years
Late onset paraplegia HEALED After 2 years
Tubercular granulation tissue,Sequestra, abscess,Caseous tissue
Stretching of cord,Myelomalacia,Internal gibbus,
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Depends on the severity of involvement of long tracts
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Cold abscess / sinuses
Constitutional symptoms: fever, wt loss, night cries (Children)
Back pain is earliest & common symptom
Weakness paraplegia
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> 50% of bone destruction before seen radiologically
Classic Radiological triad
Primary Vertebral lesion
Disc space narrowing
Paravertebral abscess
Typical tubercular spondylitic features in
long standing paraspinal abscesses
Aneurysmal phenomenon
Fusiform paraspinal soft tissue shadow
Skip lesions 7-10%
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CT or USG guided aspiration : HPE / Microbiology / Culture
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3(HRZE) / 3(HRZS) + 3(HRZ)+12(HR)Paediatric age group, streptomycin (for 2 months) replaces ethambutol to avoid optic neuropathy4(HRZE) + 14(HR)
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