Spinal Cord And Root Compression

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SPINAL TUBERCULOSIS (Pott's disease of the spine)

In developing countries, spinal TB is mostly a disease of childhood or adolescence. In Britain it usually affects the middle aged and is particularly prevalent in immigrant populations. The incidence is now increasing, probably due to the development of antibiotic resistance.

The lower thoracic spine is commonly involved and the disease initially affects the intravertebral disc and spreads to adjacent vertebral bodies. Clinical features:

The classic systemic features of weight loss, night fever and cachexia arc often absent. Pain occurs over the affected area and is made worse by weight bearing. Symptoms and signs of cord compression occur in approximately 20% of cases. The onset may be gradual as pus, caseous material or granulation tissue accumulate, or sudden as vertebral bodies collapse and a kyphosis develops.

straight x-rays are characteristic.

Anterior superior or inferior angle the vertebral _-ยป-itl. body is initially involved.

The disc space collapses as the vertebral plate is destroyed.

Infective process spreads throughout the vertebral body and may involve the pedicles or facet joints.

The disc space collapses as the vertebral plate is destroyed.

MRI with gadolinium shows an epidural mass with paraspinal soft tissue swelling.

Management:

Every effort is made to establish the diagnosis. A needle biopsy is often sufficient, but occasionally an exploratory operation (costotransversectomy) is required. Long-term antituberculous therapy is commenced.

If signs of cord compression develop, decompression is necessary.

A posterior decompression, removing the remaining unaffected bone, is likely to cause instability. An anterior or posterolateral approach is therefore required.

anterior transthoracic decompression with strut graft fusion is sometimes performed. This permits clearance of pus and caseous debris without retracting the spinal cord.

posterolateral approach

(costotransversectomy): The standard approach. Several ribs are resected medially, along with the transverse processes.

posterolateral approach

(costotransversectomy): The standard approach. Several ribs are resected medially, along with the transverse processes.

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