SPONDYLITIS TUBERCULOSIS

By :
UMMU SAIDAH BAHRI
C111 12 312

Mentor :
dr. William Limoa & dr. Ricky Tambunan & dr. Moh Asri Abidin

Supervisor :
dr. Jainal Arifin SP,OT (K) Spine

DEPARTEMEN ORTHOPEDI DAN TRAUMATOLOGI FAKULTAS KEDOKTERAN UNHAS 2018

VERTEBRAL ANATOMY
 DEFINITION

 Vertebral infection caused

by Mycobacterium
Tuberculosis.

Lewandrowski, Uwe K, et al. 2011. Rothman-Simeone The Spine Sixth Edition, United States of America : Elsevier Saunders
 EPIDEMIOLOGY
O Incident
increasing incidence of TB due to increasing immunocompromised population
O Demografic
HIV positive population (CD4+ count of 50 to 200)
O Location
15% of patients with TB will have extrapulmonary involvement
The spine, and specifically, the thoracic spine is the most common
extrapulmonary site
5% of all TB patients have spine involvement

Woon Coliin, 2015. Spinal Tuberculosis. https://www.orthobullets.com/spine/2027/spinal-tuberculosis. Diakses pada 28 juli 2018.
 ETIOLOGI

 Spondilitys TB caused by
Mycbacterium Tuberculosis .
 Tb may occur from
hematogenous spread from
the primary focus of
infection outside the spine

Lewandrowski, Uwe K, et al. 2011. Rothman-Simeone The Spine Sixth Edition, United States of America : Elsevier Saunders
Infection of the spine result from:
Hematogenous PATHOGENESIS
Limfogen
Direct extension disease

Bone destruction & caseosa

necrosis

abscess forming and granulomatous at the bottom spinal cord compresion

of the anterior longitudinal ligament and periosteum

Herkowitz Harry N, et al. 2011. Rothman-Simeone The Spine Sixth Edition, United States of America : Elsevier Saunders
CLASSIFICATION

 3 Types of spondilitys TB :
a. Paradiscal Type
b. Central Type
c. Anterior Type

Lewandrowski, Uwe K, et al. 2011. Rothman-Simeone The Spine Sixth Edition, United States of America : Elsevier Saunders
 CLINICAL MANIFESTATIONS

Signs and Symptoms:

Fever
Malaise
Night Sweats
Weight loss
Back pain

Lewandrowski, Uwe K, et al. 2011. Rothman-Simeone The Spine Sixth Edition, United States of America : Elsevier Saunders
Woon Coliin, 2015. Spinal Tuberculosis. https://www.orthobullets.com/spine/2027/spinal-tuberculosis. Diakses pada 28 juli 2018.
 CLINICAL MANIFESTATIONS

Physical examination :
 kyphotic deformity (gibbus )
 Neurological deficit
 Tenderrness

Herkowitz Harry N, et al. 2011. Rothman-Simeone The Spine Sixth Edition, United States of America : Elsevier Saunders

Woon Coliin, 2015. Spinal Tuberculosis. https://www.orthobullets.com/spine/2027/spinal-tuberculosis. Diakses pada 28 juli 2018.
 DIAGNOSTIC EVALUATION

 Count blood cell

o relative lymphocytosis
o low hemoglobin

 PPD (purified protein derivative of tuberculin)

Lewandrowski, Uwe K, et al. 2011. Rothman-Simeone The Spine Sixth Edition, United States of America : Elsevier Saunders
Woon Coliin, 2015. Spinal Tuberculosis. https://www.orthobullets.com/spine/2027/spinal-tuberculosis. Diakses pada 28 juli 2018.
DIAGNOSTIC EVALUATION

The acid-fast
bacilli smear Spinal biopsy
technique

Culture Sputum
specimens/
gastric washings

Herkowitz Harry N, et al. 2011. Rothman-Simeone The Spine Sixth Edition, United States of America : Elsevier Saunders
DIAGNOSTIC EVALUATION

Plain radiographs
 Peridiscal involvement, disc
space narrowing followed by
bone destruction.

Herkowitz Harry N, et al. 2011. Rothman-Simeone The Spine Sixth Edition, United States of America : Elsevier Saunders
 DIAGNOSTIC EVALUATION

CT SCAN

 Indications :
• lesions <1.5cm (better
than radiographs)
• inaccurate for defining
epidural extension

Woon Coliin, 2015. Spinal Tuberculosis. https://www.orthobullets.com/spine/2027/spinal-tuberculosis. Diakses pada 28 juli 2018.
 DIAGNOSTIC EVALUATION
MRI
1. low signal on T1-weighted
images, bright signal on T2-
weighted images
2. presence of a septate pre-/
paravertebral / intra-osseous
smooth walled abscess with a
subligamentous extension and
breaching of the epidural
space
3. end-plate disruption
4. Paravertebral soft tissue shadow
5. high signal intensity of the disc on the T2weighted image

Lewandrowski, Uwe K, et al. 2011. Rothman-Simeone The Spine Sixth Edition, United States of America : Elsevier Saunders
Woon Coliin, 2015. Spinal Tuberculosis. https://www.orthobullets.com/spine/2027/spinal-tuberculosis. Diakses pada 28 juli 2018.
DIFFERENTIAL DIAGNOSIS

 Piogenic infections
 Vertebral Tumors

Herkowitz Harry N, et al. 2011. Rothman-Simeone The Spine Sixth Edition, United States of America : Elsevier Saunders
 1. Agents
Isoniazid (H), Rifampin (R), Ethambutol (E) and
Pyrazinamid (Z)
2. Regimen
RHZE for 2 months, then RH for 9 to 18 months

Lewandrowski, Uwe K, et al. 2011. Rothman-Simeone The Spine Sixth Edition, United States of America : Elsevier Saunders
Woon Coliin, 2015. Spinal Tuberculosis. https://www.orthobullets.com/spine/2027/spinal-tuberculosis. Diakses pada 28 juli 2018.
 Anterior decompression, bone Pedicle subtraction
grafting, anterior plating osteotomy

Woon Coliin, 2015. Spinal Tuberculosis. https://www.orthobullets.com/spine/2027/spinal-tuberculosis. Diakses pada 28 juli 2018.