Pott's disease Classification: Difference between revisions
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==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]]. | ||
*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]]. | ||
*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]] | |||
{| class="wikitable" | {| class="wikitable" | ||
!Stage | !Stage | ||
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|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 | ||
|} | |} |
Revision as of 14:59, 24 March 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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.
- 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.
- 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
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 |