Untitled Quiz

Tuberculosis of the Spine (Pott's Disease)

• Tuberculosis of the spine, also known as Pott's disease or spondylitis, is a form of extrapulmonary tuberculosis affecting the vertebrae.
• Caused by Mycobacterium tuberculosis, primarily in developing countries.
• A major cause of morbidity due to potential deformity and neurological complications.

Causes

• Infection by Mycobacterium tuberculosis: Hematogenous spread from a primary site, often the lungs.
• Direct spread from nearby infected tissues.
• Risk factors:
  • Weakened immune systems (e.g., due to HIV/AIDS)
  • Malnutrition
  • Substance abuse
  • Diabetes

Symptoms

• Symptoms are often vague, especially early on.
• Neurological symptoms can include weakness, numbness, tingling, or paralysis due to spinal cord/nerve pressure.
• Thoracic and lumbar spine are typical sites of infection.
• Manifestations (signs):
  • Back pain and stiffness
  • Spinal deformities (kyphosis/scoliosis)
  • Neurological deficits (weakness/paralysis)
  • Fever, night sweats, and weight loss
  • Abscess formation
  • Joint deformities/scoliosis
  • Swelling
  • Decreased range of motion
  • Ulcers
  • Swollen lymph nodes
  • Cold abscess (pus pockets)

Diagnosis

• Medical history and physical examination
• Imaging studies (X-ray, MRI, or CT scan)
• Laboratory tests:
  • Acid-fast bacilli culture
  • ESR (Erythrocyte Sedimentation Rate)
  • CRP (C-reactive protein)
  • Tuberculin skin test/Mantoux test
• Definitive diagnosis: Biopsy and microbiological culture

Treatment

• Antitubercular therapy (ATT): 6-12 months, including medications like isoniazid, rifampicin, pyrazinamide, ethambutol, and/or streptomycin (often for the first 2 months). Continuation of isoniazid and rifampicin often continues for 4-12 months or longer.
• Combination multidrug antitubercular therapy is the standard approach for Pott's spine.
• Surgical intervention: Drainage of abscesses, decompression, or spinal stabilization if needed; procedures depend on the extent of bone damage.
  • Debridement (cleaning infected tissues)
  • Removing eroded bone
  • Placing screws and rods or fusing vertebrae together
  • Bone grafting (using a bone taken from another part of the body.

Complications

• Spinal deformity (gibbus deformity)
• Neurological deficits (paraplegia/quadriplegia)
• Chronic pain (nerve compression), and disability
• Abscess formation and spread of infection

Prevention

• Early diagnosis and treatment of pulmonary tuberculosis is crucial to minimize the risk of spinal TB.
• Vaccination with BCG
• Improved living conditions and hygiene
• Regular check-ups for at-risk populations

Nursing Management

• Initial Assessment: History and physical examination, collecting information about any TB exposure, symptoms, neurological deficits.

• Diagnostic Tests: Ensuring patient compliance, monitoring lab tests (ESR, CRP) for inflammation.

• Medication Management (ATT): Administering medications according to DOTS (Directly Observed Treatment, Short-course) regimen. Monitoring for adverse effects (hepatotoxicity, peripheral neuropathy, visual disturbances). Emphasize patient adherence.

• Pain and Symptom Management: Administer prescribed analgesics or NSAIDs, encourage non-pharmacological pain relief (relaxation techniques, heat applications)

• Spinal Care: Using braces or orthotics if recommended. Patient education about posture and movements.

• Preventing Complications: Neurological monitoring (for signs of spinal cord compression: weakness, numbness, incontinence), reporting any changes in motor/sensory function. Infection control, teaching respiratory hygiene and infection control measures especially in healthcare settings. Monitoring wound sites for infection.

• Nutrition and Lifestyle modifications: promoting a protein-rich diet, micronutrients (Vitamin D, calcium). Address weight loss and malnutrition issues. Educate patients on lifestyle changes (avoiding tobacco and alcohol)

• Rehabilitation and Mobility: Collaborating with physiotherapists, providing gradual mobilization and tailored rehab programs for patients with neurological impairments. Encouraging bed rest during acute phases but preventing immobility issues (getting up and moving, frequent repositioning).

• Patient Education and Psychological Support: Addressing fears about paralysis or TB stigma, educating patients about the long-term nature of the disease, ensuring follow-up care, potentially connecting with support groups or counseling if needed.

• Surgical considerations: Proper pre and post-operative care if applicable. Monitor wounds for infection and implement proper postoperative rehabilitation strategies.

Regular Follow-Up

• Monitoring for adherence to treatment and response.
• Evaluating for signs of drug resistance or recurrence.
• Reinforcing follow-up imaging and lab tests to assess recovery.