Pott's disease Classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]
Overview
Pott's disease resulting in extensive vertebral damage can result in spinal cord compression. Paraplegia as a result of cord compression is classified based on the timing of onset and the severity of the symptoms.
Classification
Paraplegia is classified into early and late paraplegia based on the activity of the tuberculous infection:
Based on the Onset of Paraplegia
Early Paraplegia
- It develops in the active stage of tuberculosis infection, commonly seen in adults within 2 years of infection.[1]
- The spinal cord compression is due to the pressure from the necrotic debris from the damaged bone and intervertebral disc, pus and the granulation tissue.
- Spinal cord compression in spinal tuberculosis can result from other causes causing compression such as subluxation and dislocation due to destruction of anterior column, compression fracture as a result of wide spread infection, spread of infection to the spinal cord, arterial thrombosis and formation of a intra or extramedullary tuberculoma of the spinal cord.[2][3][4]
- Emergent treatment is warranted in patients presenting with early paraplegia.
Late Paraplegia
- It is a complication that develops in a patient with healed tuberculosis. The timing of presentation is variable and can occur 2 or 3 decades after the active infection. Typically it is defined as neurological symptoms appearing after 2years of primary infection.
Stages of Spinal tuberculosis
The following table describes the stages of spinal tuberculosis:[5]
| Stage | Description | Imaging Findings | Duration |
|---|---|---|---|
| I | Stage of implantation, Incipient stage or Predestructive stage |
|
Less than 3 months |
| II | Stage of early destruction | Diminished disc space, paradiskal erosion, kyphosis <10°( Kyphosis stage 1) | 2–4 months |
| III | Stage of advanced destruction and collapse | 3–9 months | |
| IV | Stage of neurological involvement | Stage III or IV with grade 4 paraplegia | Variable |
| V | Stage of residual deformity and aftermath | Kyphosis stage 1 to 3, disease active locally grumbling, reactivated or healed | 3–5 years |
References
- ↑ Aydın T, Taşpınar Ö, Keskin Y, Kepekçi M, Güneşer M, Çamlı A; et al. (2016). "A Rare Complication of Tuberculosis: Acute Paraplegia". Ethiop J Health Sci. 26 (4): 405–7. PMC 4992782. PMID 27587940.
- ↑ Klausnitzer M, Kalff R, Waschke A (2016). "[Intramedullary tuberculoma--rare differential diagnosis of paraplegia]". MMW Fortschr Med. 158 (6): 57–8. doi:10.1007/s15006-016-8004-8. PMID 27084163.
- ↑ Liu J, Zhang H, He B, Wang B, Niu X, Hao D (2016). "Intramedullary Tuberculoma Combined with Abscess: Case Report and Literature Review". World Neurosurg. 89: 726.e1–4. doi:10.1016/j.wneu.2016.01.021. PMID 26805697.
- ↑ Mishra SS, Das D, Das S, Mohanta I, Tripathy SR (2015). "Spinal cord compression due to primary intramedullary tuberculoma of the spinal cord presenting as paraplegia: A case report and literature review". Surg Neurol Int. 6: 42. doi:10.4103/2152-7806.153844. PMC 4392528. PMID 25883834.
- ↑ Ekinci S, Ersen O, Ekinci GH (2015). "Grade-III Paraplegia in Spinal Tuberculosis". J Clin Diagn Res. 9 (4): RL01–2. doi:10.7860/JCDR/2015/11812.5843. PMC 4437129. PMID 26023613.