Tuberculosis of the Spine PDF

Tuberculosis of the Spine An Overview of Spinal Tuberculosis (Pott's Disease)  Introduction Tuberculosis of the spine, also known as Pott's disease or Tuberculosis spondylitis, is a form of extrapulmonary tuberculosis that affects the vertebrae. It is c...

Tuberculosis of the Spine An Overview of Spinal Tuberculosis (Pott's Disease)  Introduction Tuberculosis of the spine, also known as Pott's disease or Tuberculosis spondylitis, is a form of extrapulmonary tuberculosis that affects the vertebrae. It is caused by Mycobacterium tuberculosis and primarily occurs in developing countries. This condition is a major cause of morbidity due to its potential to cause deformity and neurological complications.  Causes 1. Infection by Mycobacterium tuberculosis - hematogenous spread from a primary site, often in the lungs. 2. Direct spread from nearby infected tissues. Some Risk Factors include i. Weakened immune system due to HIV/AIDS, ii. Malnutrition, iii. Substance abuse, iv. Diabetes,  Spinal tuberculosis can put pressure on the spinal cord and nerves that exit the spine, causing neurological symptoms such as weakness in the legs, numbness, tingling, or even paralysis Spinal tuberculosis typically affects the thoracic spine in the upper back and the lumbar spine in the lower back. Symptoms of spinal tuberculosis are vague, particularly early on. i. Joint deformities/scoliosis (an abnormal curve in the spine) ii. Swelling iii. Decreased range of motion iv. Ulcers v. Swollen lymph nodes vi. Cold abscess (pockets of pus)  Manifestations 1. Back pain and stiffness 2. Spinal deformity (kyphosis/scoliosis). 3. Neurological deficits (weakness or paralysis). 4. Fever, night sweats, and weight loss. 5. Abscess formation.  While many people exposed to M. tuberculosis won't have any symptoms, some may have a latent TB infection that may develop into active TB. Testing for latent TB is recommended for anyone at greater risk of exposure  Diagnosis 1. Medical history and physical examination. 2. Imaging studies: X-ray, MRI, or CT scan. 3. Laboratory tests: Acid-fast bacilli culture, ESR, CRP, and tuberculin skin test/Mantoux test 4. Biopsy and microbiological culture for definitive diagnosis.  Treatment 1. Antitubercular therapy (ATT) for 6–12 months. (Isoniazid, rifampicin, pyrazinamide, ethambutol and/or streptomycin for two months. Continuing isoniazid and rifampicin for 4 to 12 months or longer.) In Pott's spine, combination multidrug antitubercular therapy is the basis of treatment 2. Surgical intervention for abscess drainage, decompression, or spinal stabilization. 3. Supportive care: pain management and physical therapy.  Spinal tuberculosis often requires surgery as part of treatment. The exact procedures used depend on the extent of bone damage. Surgery can include cleaning out infected tissues (called debridement), removing eroded bone, placing screws and rods to stabilize the spine, or fusing vertebrae together. Surgery can also involve bone grafting—taking a piece of bone from one place in the body and grafting it into the spin  Types of surgery may include: Debridement: Cleaning or removing damaged tissue around your spine. Drainage: Removing or draining the pus-filled abscesses collected in your spinal column. Stabilization and alignment: A surgeon may remove and/or repair broken bones and disks and add plates and screws to hold your bones in place. Fusion: A surgeon may permanently join two vertebrae together to limit their movement, which can prevent pain and other complications. Your surgeon may use a piece of bone from another part of your body (a bone graft) to help the two vertebrae fuse together.  Complications 1. Spinal deformity (gibbus deformity). 2. Neurological deficits (paraplegia or quadriplegia). 3. Chronic pain (nerve compression) and disability. 4. Abscess formation and spread of infection.  Prevention 1. Early diagnosis and treatment of pulmonary tuberculosis. 2. Vaccination with BCG. 3. Improved living conditions and hygiene. 4. Regular health check-ups for at-risk populations.  NURSING MANAGEMENT Initial Assessment History and Physical Examination: Collect patient history for TB exposure, symptoms (back pain, stiffness, fever, weight loss). Evaluate neurological status (motor, sensory deficits). Diagnostic Tests: Ensure patient compliance with diagnostic procedures: X-ray, MRI, CT scans, TB culture, or biopsy. Monitor lab tests, including ESR and CRP, for inflammation.  Medication Management Antitubercular Therapy (ATT): Administer medications as per the DOTS (Directly Observed Treatment, Short-Course) regimen. Common drugs include isoniazid, rifampin, pyrazinamide, and ethambutol. Monitor for adverse effects (hepatotoxicity, peripheral neuropathy, visual disturbances). Educate the patient on the importance of adherence to the full course of therapy.  Pain and Symptom Management Pain Control: Administer prescribed analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs). Encourage the use of non-pharmacological methods like heat application or relaxation techniques. Spinal Care: Use braces or orthotic devices to support the spine if recommended. Educate the patient on proper posture and movements to avoid worsening the condition.  Preventing Complications Neurological Monitoring: Watch for signs of spinal cord compression (weakness, numbness, incontinence). Report changes in motor or sensory function promptly. Infection Control: Practice and teach respiratory hygiene to prevent the spread of TB. Encourage adherence to infection control measures, especially in healthcare settings.  Nutrition and Lifestyle Modifications Promote a diet rich in: Protein to aid healing and recovery. Micronutrients (Vitamin D, calcium) to support bone health. Address weight loss or malnutrition issues. Educate the patient on lifestyle changes, including avoiding smoking and alcohol.  Rehabilitation and Mobility Collaborate with physiotherapists for: Gradual mobilization and exercises to maintain or regain spinal function. Tailored rehabilitation programs for patients with neurological impairments. Encourage bed rest during acute phases but prevent prolonged immobility to reduce the risk of complications like bedsores or deep vein thrombosis. Patient Education and Psychological Support Provide emotional support to address fears about paralysis or stigma associated with TB. Educate about the chronic nature of the disease and the importance of follow-up care. Connect patients with support groups or counseling services if needed.  Surgical Considerations (if applicable) Assist in pre- and post-operative care for patients undergoing surgery for spinal decompression or stabilization. Monitor wound sites for infection and ensure proper postoperative rehabilitation. Regular Follow-Up Monitor for treatment adherence and response. Evaluate for signs of drug resistance or recurrence of symptoms. Reinforce follow-up imaging or lab tests to assess recovery.