M.

Yasier Aruna
SPONDILITIS 1914201310074
TUBERKULOSIS
DEFINISITION
Tuberculous spondylitis (TB) or known as Pott's disease is an infectious disease caused by the Mycobacterium tuberculosis
bacteria that affects the spine. Tuberculous spondylitis has been found in mummies from Spain and Peru in 1779.
Mycobacterium tuberculosis infection of the spine is mostly transmitted by infection from the disc. The mechanism of
infection is mainly by spread through hematogenous (Epi, Purniti, Subanada, & Astawa, 2008).

Spinal tuberculosis or known as TB spondylitis is an extrapulmonary TB incident to the spine of the body (Brunner, Suddart, & Smeltzer,
2008).
CLASSIFICATION
Tuberculous spondylitis is classified according to the Gulhane Askeri tip of academia
(GATA) into 5 groups

This classification system is based on clinical and radiological criteria including: abscess formation, disc
degeneration, vertebral collapse, kyphosis, sagittal angulation, vertebral instability, and neurological deficits.
ETIOLOGY
Tuberculosis is an infectious disease caused by the bacteria Mycobacterium
tuberculosis which is a member of the order actinomycetales and the mycobacteriase
family. The tubercle bacilli are curved rods, weak gram-positive, that is difficult to
stain, but once stained are difficult to remove even with acids, so they are called
acid-fast bacilli. This is because bacteria have thick cell walls consisting of a layer of
wax and fat (mycolic fatty acids). In addition, it is pleimorphic, does not move and
does not form spores and has a length of about 2-4 m (Epi, Puriti, Subanada, &
Astawa, 2008)
PATHOPHYSIOLOGY
Tuberculosis of the spine can occur due to hematogenous spread or direct spread of the para-aortic
lymph nodes or via the lymphatic pathways to the bone from a pre-existing focus of tuberculosis outside
the spine. On appearance, the primary infection focus of tuberculosis can be calm. The most common
source of infection is from the pulmonary and genitourinary systems.

Basil enters the vertebral body through 2 main routes, arterial and venous routes as well as auxiliary
pathways.

Spread of bacilli can occur via the intercostal or lumbar arteries that provide blood supply to two
adjacent vertebrae, namely the lower half of the vertebra above and the upper half of the vertebra below or
through Batson's plexus that surrounds the vertebral column causing multiple vertebrae to be involved.
CLINICAL MANIFESTATION
The clinical manifestations of TB spondylitis are relatively indolent (painless). Patients
usually complain of nonspecific local pain in the area of ​the infected vertebra. Subfebrile fever,
chills, malaise, weight loss or age-appropriate body weight in children, which are classic
symptoms of pulmonary TB, also occur in patients with TB spondylitis. In patients with positive
HIV serology, the median duration from onset of symptoms to diagnosis was 28 weeks. If a
deformity in the form of kyphosis is found, the pathogenesis of spinal TB is generally already
running for approximately three to four months (Zuwanda & Janitra, 2013).
 MANAGEMENT
A. Conservative therapy

1. Nutritious nutrition

2. Administration of chemotherapy or anti-tuberculosis therapy

3. Rest in bed

4. Immobilization

B. Operative therapy

The goal of operative therapy is to remove the source of infection, correct the deformity, eliminate neurologic complications and
further damage. One of the most important surgical procedures is debridement, which aims to remove the source of infection by
removing all debris and necrotic tissue, foreign bodies and micro-organisms.