Pott's disease Classification: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Pott's disease}} | {{Pott's disease}} | ||
{{CMG}} | {{CMG}} {{AE}} {{AKI}} | ||
==Overview== | ==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== | ==Classification== | ||
Paraplegia | [[Paraplegia]] is classified into early and late [[paraplegia]] based on the activity of the [[Mycobacterium tuberculosis|tuberculous]] [[infection]]: | ||
===Based on the Onset of Paraplegia=== | ===Based on the Onset of Paraplegia=== | ||
====Early Paraplegia==== | ====Early Paraplegia==== | ||
*It develops in the active stage of tuberculosis infection, commonly seen in adults within | *It develops in the [[active stage]] of [[tuberculosis]] [[infection]], commonly seen in adults within 2 years of [[infection]].<ref name="pmid27587940">{{cite journal| author=Aydın T, Taşpınar Ö, Keskin Y, Kepekçi M, Güneşer M, Çamlı A et al.| title=A Rare Complication of Tuberculosis: Acute Paraplegia. | journal=Ethiop J Health Sci | year= 2016 | volume= 26 | issue= 4 | pages= 405-7 | pmid=27587940 | doi= | pmc=4992782 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27587940 }} </ref> | ||
*The spinal compression is due to the pressure from the necrotic debris from the damaged bone and intervertebral disc, pus and the granulation tissue. | *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 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. | *[[Spinal cord]] compression in [[Pott's disease|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]].<ref name="pmid27084163">{{cite journal| author=Klausnitzer M, Kalff R, Waschke A| title=[Intramedullary tuberculoma--rare differential diagnosis of paraplegia]. | journal=MMW Fortschr Med | year= 2016 | volume= 158 | issue= 6 | pages= 57-8 | pmid=27084163 | doi=10.1007/s15006-016-8004-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27084163 }} </ref><ref name="pmid26805697">{{cite journal| author=Liu J, Zhang H, He B, Wang B, Niu X, Hao D| title=Intramedullary Tuberculoma Combined with Abscess: Case Report and Literature Review. | journal=World Neurosurg | year= 2016 | volume= 89 | issue= | pages= 726.e1-4 | pmid=26805697 | doi=10.1016/j.wneu.2016.01.021 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26805697 }} </ref><ref name="pmid25883834">{{cite journal| author=Mishra SS, Das D, Das S, Mohanta I, Tripathy SR| title=Spinal cord compression due to primary intramedullary tuberculoma of the spinal cord presenting as paraplegia: A case report and literature review. | journal=Surg Neurol Int | year= 2015 | volume= 6 | issue= | pages= 42 | pmid=25883834 | doi=10.4103/2152-7806.153844 | pmc=4392528 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25883834 }} </ref> | ||
*Emergent treatment is warranted in patients presenting with early paraplegia. | *Emergent [[treatment]] is warranted in patients presenting with early [[paraplegia]]. | ||
====Late 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. | *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=== | ===Stages of Spinal tuberculosis=== | ||
The following table describes the stages of [[Pott's disease|spinal tuberculosis]]:<ref name="pmid26023613">{{cite journal| author=Ekinci S, Ersen O, Ekinci GH| title=Grade-III Paraplegia in Spinal Tuberculosis. | journal=J Clin Diagn Res | year= 2015 | volume= 9 | issue= 4 | pages= RL01-2 | pmid=26023613 | doi=10.7860/JCDR/2015/11812.5843 | pmc=4437129 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26023613 }} </ref> | |||
{| class="wikitable" | {| class="wikitable" | ||
!Stage | !Stage | ||
| Line 27: | Line 29: | ||
|Stage of implantation, Incipient stage or Predestructive stage | |Stage of implantation, Incipient stage or Predestructive stage | ||
| | | | ||
*Straightening of the spine or loss of curve | *Straightening of the [[spine]] or loss of curve | ||
| | |Less than 3 months | ||
|- | |- | ||
|II | |II | ||
|Stage of early destruction | |Stage of early destruction | ||
|Diminished | |Diminished [[disc space]], [[paradiskal erosion]], [[kyphosis]] <10°( Kyphosis stage 1) | ||
|2–4 months | |2–4 months | ||
|- | |- | ||
|III | |III | ||
|Stage of advanced destruction and collapse | |Stage of advanced destruction and [[collapse]] | ||
| | | | ||
*2 or more vertebral involvement with collapse | *2 or more [[vertebral]] involvement with [[collapse]] | ||
*Kyphosis 11°-60° ( | *[[Kyphosis]] 11°-60° (Kyphosis stage 2) or | ||
*Gibbus > 60° ( | *[[Gibbus]]> 60° (Kyphosis stage 3) | ||
|3–9 months | |3–9 months | ||
|- | |- | ||
|IV | |IV | ||
|Stage of neurological involvement | |Stage of [[neurological]] involvement | ||
|Stage III or IV with grade 4 paraplegia | |Stage III or IV with grade 4 [[paraplegia]] | ||
|Variable | |Variable | ||
|- | |- | ||
|V | |V | ||
|Stage of residual deformity and aftermath | |Stage of residual [[deformity]] and aftermath | ||
|Kyphosis | |[[Kyphosis]] stage 1 to 3, disease active locally [[grumbling]], [[reactivated]] or [[healed]] | ||
|3–5 years | |3–5 years | ||
|} | |} | ||
Latest revision as of 16:07, 4 April 2017
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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.