Tuberculosis of the Spine (Pott's Disease)
Pott's Disease is the most common form of skeletal tuberculosis (50%). It typically affects the Thoracolumbar junction and destroys the vertebral bodies and intervening disc.
1. Pathology
- Paradiscal Lesion: The most common type. Infection starts in the metaphysis of the vertebral body, spreads under the ALL, and destroys the adjacent disc. (Two vertebrae + One disc involvement).
- Cold Abscess: Pus formation without acute signs of inflammation (heat/redness). Can track along Psoas muscle.
- Gibbus Deformity: Severe kyphosis (hunchback) due to anterior collapse of vertebrae.
2. Clinical Features
- Night pain and night cries (in children).
- Constitutional symptoms: Fever (evening rise), weight loss, anorexia.
- Spinal stiffness ("Coin test": Child cannot pick up coin without bending knees).
3. Management
- Medical (Mainstay): Anti-Tubercular Therapy (ATT) for 9-18 months.
- Rest: Bed rest/Bracing (ASH brace or Taylor brace) in acute phase.
- Surgery: Hong Kong Operation (Debridement + Bone Grafting) if neurologic deficit or severe deformity.
25 Practice MCQs
Q1. The most common site for Spinal TB is:
Answer: A). High mobility area.
Q2. The "Paradiscal" lesion involves:
Answer: A). Disc space narrowing is the earliest X-ray sign (unlike tumor where disc is preserved).
Q3. Why is it called a "Cold Abscess"?
Answer: A). Chronic inflammation produces pus without heat.
Q4. Gibbus deformity is:
Answer: A). "Knuckle" on the back.
Q5. A Psoas Abscess typically presents as:
Answer: A). Pus tracks down the sheath, causing spasm.
Q6. Earliest symptom in children is often:
Answer: A). Protective muscle spasm disappears in sleep -> bone rubs bone -> cry.
Q7. The "Hong Kong Operation" refers to:
Answer: A). Addresses the anterior pathology directly.
Q8. Disc space preservation suggests:
Answer: A). Tumors respect the disc; TB destroys it early.
Q9. Central type of Spinal TB (body destruction sparing disc) mimics:
Answer: A). Less common than paradiscal.
Q10. "Bird's Nest" appearance on MRI/CT indicates:
Answer: A). Old healed disease.
Q11. Pott's Paraplegia occurs due to:
Answer: A). Mechanical compression of the cord.
Q12. Which brace is typically used for Thoracolumbar TB?
Answer: A). Anterior Spinal Hyperextension brace limits flexion.
Q13. Spread of TB to the spine is usually:
Answer: A). Secondary to pulmonary or GU infection.
Q14. Anterior Decompression is preferred over Laminectomy because:
Answer: A). Laminectomy removes the only remaining stable column (Posterior).
Q15. Pott's spine was described by Percivall Pott in:
Answer: A). Historical fact.
Q16. "Skipped Lesions" (Non-contiguous) occur in:
Answer: A). Always image the whole spine.
Q17. Spina Ventosa is:
Answer: A). Bone expansion due to granulation tissue.
Q18. MRI feature "Rim Enhancement" of abscess indicates:
Answer: A). Typical of TB abscess.
Q19. Retropharyngeal Abscess (Cervical TB) can cause:
Answer: A). Pus pushes the pharynx forward.
Q20. The "Middle Path" regimen (Tuli) advocates:
Answer: A). Conservative first, surgery if needed.
Q21. Healed Spinal TB usually results in:
Answer: A). Bony ankylosis.
Q22. ESR in active TB is:
Answer: A). Used to monitor treatment response.
Q23. Posterior Spinal TB (Neural arch) is rare but risky because:
Answer: A). The posterior elements protect the cord closely.
Q24. Costotransversectomy is a surgical approach to:
Answer: A). Removing rib head and transverse process.
Q25. Is biopsy mandatory?
Answer: A). Especially in MDR-TB era.
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