REFERAT

TUBERCULOUS
SPONDYLITIS

Dr. dr. Erwien Isparnadi, Sp.OT

By:
Tomy Wijaya Kurniawan 201520401011128
Idza Fariha Afri
201520401011149
RSU HAJI SURABAYA
TAHUN 2016
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Anatomy

1. Vertebral artery and cervical artery ascendens in the

cervical region
2. intercostalis artery posterior in the thorakal regio
3. subcostalis artery and lumbalis artery in the lumbal
regio
4. iliolumbalis artery and sacralis lateralis artery

Definition
Tuberculous Spondylitis

Tuberculosis
of
the
spine also known as
tuberculous spondylitis
is
a
chronic
granulomatous
inflammation
that
is
destruction
by
tuberculosis
mikrobakterium.

Epidemiology

Pott's disease is associated with socioeconomic factors and

exposure to infection .
Tuberculous spondylitis is 50 % of all tuberculosis of bones
and joints that occur . Indonesia is a country with
tuberculosis patients ( TB ) 5rd highest in the world after
India, Tiongkok, Nigeria and Pakistan.

Etiology

Tuberculosis of the spine is a secondary infection of

tuberculosis elsewhere in the body, 90-95 % are
caused by mycobacterium tuberculosis.

Phatogenesis

The disease is divided into

five stages:

Based on the location of the initial infection in the

vertebral body recognized three forms of ankylosing
a) Peridiskal / paradiskal
b) Central
c) Atipikal

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Clinical Manifestations
Local pain
Subfebril fever , chills , malaise
Decreased appetite
Lose of weight
Neurological deficits : paraplegia , paresis ,
hypesthesia , radicular pain
Disfagi , stridor , shortness of breath

12

Classification
Pott's Paraplegi Classification

13

Clinico-radiological Classification

14

GATA Classification

15

ASIA Classification

16

Diagnosis

Anamnesis :
a history of tuberculosis ,
paraparesis , defecation and
micturition disorders
Physical examination

17

lab
1. Erythrocyte sedimentation rate increases.
2. Tuberculin skin test / Mantoux test / Tuberculine Purified
Protein Derivative (PPD) positive.
3. Peripheral blood smear showed leukocytosis with
lymphocytosis relative.

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Foto Rongen
Early signs of infection osteoporosis intervertebral
disc space narrowing, bone destruction and
collapse looks vertebral body adjacent to the
other, resulting in spinal deformity angled

19

CT Scan
CT - scan can clearly show bone sclerosis,
destruction of vertebral bodies, epidural
abscess, bone fragmentation, and the
narrowing of the spinal canal.

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MRI

21

Pathologi Anatomy

epithelioid cell granulomas , necrotic granular with

lymphocytic infiltration and multinucleated Langhans
giant cells spread and caseating necrosis .
22

Differential Diagnosis
Pyogenic infections ( eg, staphylococcal /
suppurative spondylitis ) .
Enteric infections (eg typhoid , parathypoid )
Tumors / malignancies ( leukemia , Hodgkin 's
disease, eosinophilic granuloma , aneurysm
bone cyst and Ewing's sarcoma )
Scheuermann 's disease

23

Conservative Therapy
1.Bed rest (bed rest )
2.Improving the general condition of patient
3.Anti- tuberculosis drugs:

24

Operatif

Operative action is if there is a cold abscess ,

tuberculous lesions , paraplegi and kyphosis .
There are three ways to eliminate tuberculosis
lesions, namely :
a. local debridement
b. Kosto transveresektomi
c. Debridemant radical accompanied focal bone graft
on the front .

Paraplegia
Handling can be done in paraplegia are:

Treatment with chemotherapy

laminectomy
Kosto - transveresektomi
radical surgery
The bone wedge osteotomy is closed from behind .
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Prevention
Bacillus Calmette - Guerin vaccine ( BCG ).
BCG stimulates immunity , increase
endurance without causing harmful things .

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Complication
a. Corda spinal injury (spinal cord injury )
b. Empyema due to tuberculosis in thoracic
paravertebral abscess rupture into the
pleural

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Prognosis
The prognosis of patients affected by
tuberculosis spondylitis :
age , kifotik deformity , lesion ,
neurological deficits , early diagnosis ,
spinal fusion , comorbid , educational and
socioeconomic levels .
The presence of resistant TB spondylitis
OAT worsen the prognosis.
Other comorbidities such as AIDS related
to poor prognosis

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