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Purpose: Grading of The Neurological Deficit
Purpose: Grading of The Neurological Deficit
Purpose
Describe the natural history spinal
tuberculosis, classifications and principles of
based upon the grading of the
neurological deficit.
Methods
Review of literature to provide the clinicoradiological correlation of the natural history
of spinal tuberculosis in different stages.
Abstract
Results
A five stage natural history of spinal tuberculosis :
Stage of neurological involvement divided into 4 grades:
1) Negligible
2) Mild
3) Moderate
4) severe with sensory and autonomic dysfunctions.
Suitable principles of management role of rest, braces,
chemotherapy and surgery.
Neurological deficit grading based management:
1) Grade 1 and 2 conservative treatment
2) Grade 3 gray zone
3) Grade 4 operative treatment
Abstract
Conclusion
Management of tuberculosis of spine no
different than management of soft tissue
tuberculosis.
Role of surgery very limited.
Management of tubercular paraplegia
based upon the grading of paraplegia
simple, logical, efficient and easy to
understand and remember by any orthopedic
surgeon
Introduction
Introduction
Osteoarticular
tuberculosis
localized
manifestation of a systemic disease.
Mycobacterium tuberculosis lodged in the bone
and joints through hematogenous route and spine is
no exception.
In osteoarticular tuberculosis spinal involvement
(50 % of cases)
Mycobacterium tuberculosis can be lodged in the
vertebral body (anterior spinal tuberculosis) 9095
% or in the various components of posterior
vertebral arch (posterior spinal tuberculosis) 510 %
Introduction(2)
Classification of Potts
paraplegia
This classification of paraplegia based upon
the onset of disease unrealistic because onset
of disease begins with the implantation and
lodgement of mycobacterium tuberculosis to the
spine
Similarly classification based upon the status
of disease proposed by Butler as subgroups of
early and late onset of paraplegia :
(a) paraplegia of active disease
(b) paraplegia with apparent quiescence of
disease
Classification
Classification
Confirmation of diagnosis
Clinical history
Examination
Radiological evaluation
Hematological, microbiological, serological,
immunological and other available diagnostic
tools should be used to clinch the
diagnosis
When in doubt, tissue biopsy (needle or
open) for bacteriological and pathological
confirmation should be obtained
Confirmation of diagnosis(2)
Enforced and prolonged rest on hard bed or Plasterof Paris bed (6-9 months) causing dermatological,
pulmonary,
abdominal
and metabolic problems.
Treatment of Potts
Paraplegia
Conservative Therapy
Gray Zone
Gray Zone.(2)
Operative Surgical
Treatment
Operative Surgical
Treatment.(2)
multiple
causes
(extrinsic/compressive
and
intrinsic/destructive) often exist need surgical
decompression to get some neurological recovery
Conclusion