Granulomatous Infection  

Posted bythespinebookadminPosted inTopics, Tumor

Background 

  • TB (Pott’s disease) 
    • Osteo, kyphosis, mechanical instability 
  • Other 
    • Brucellosis, actinomyces, nocardia, fungal, parrasitic 
  • Location: thoracic 
  • Caseating granuloma 

3 Patterns 

  • Peridiscal (most common)  
  • Central – VB collapse and deformity 
  • Anterior – anterior to VB, posterior to ALL 

Pyogenic vs TB 

  • Paraspinal abscess formations (50%) 
    • Anterior and large (more common in TB than pyogenic) 
  • Initially not involve disc space 
  • More deformity than pyogenic infections 
    • Mean deformity non op 15 
    • Higher progression when involving VB and posterior elements 
  • Adults 
    • Static kyphosis 
  • Peds 
    • Progressive in 40% because growth 

Investigation 

  • CBC, CRP ESR, C&S 
  • AFB 

Management 

  • Medial 
    • RIPE x 6 months 
    • Rifampin 
    • Isoniazid 
    • Pyramidol 
    • Ethambutol 
  • Surgery 
    • Fusion 
    • Excision 
    • Recon of anterio with structual allograft (fibular) or Ti cage 

RC Questions 

All true about spine TB except: 

In vertebral bodies 

More severe kyphotic deformity in kids 

Pre and paravertebral septate collections common 

Kyphosis deformity more common in lumbar spine