Escolar Documentos
Profissional Documentos
Cultura Documentos
Introduction
Pott disease, also known as tuberculous spondylitis or Davids Disease One of the oldest demonstrated diseases of humankind having been documented in spinal remains from the Iron Age and in ancient mummies from Egypt and the Pacific coast of South America.
Introduction Contd
In 1779, Sir John Percivall Pott, for whom the disease is named, presented the classic description of spinal tuberculosis.
Introduction Contd
Grave disorder that produces the destruction of the vertebrae Can cause inflammation of the bones and collapse of the vertebrae Resulting to compression of the spinal cord and nerve. (As shown in the animation.)
Introduction Contd
Usually occurring on the Kthoracic and vertebral region. The disease may occur in adulthood or childhood.
Introduction Contd
Since the advent of anti-tuberculous drugs and improved public health measures, spinal tuberculosis has become rare in industrialized countries, although it is still a significant cause of disease in developing nations.
Introduction Contd
Tuberculosis involvement of the spine has the potential to cause serious morbidity, including permanent neurologic deficits and severe deformities.
Introduction Contd
Medical treatment or combined medical and surgical strategies can control the disease in most patients.
Mode of transmission:
Secondary to an extra spinal source of infection (Mycobacterium tuberculae) Inhalation of airborne droplets ( M. tuberculae) Hematogenous
Risk Factors
Close contact with people with active PTB Poor socioeconomics Malnutrition Immuno-compromised people Living in crowded area Health care workers Therapeutic immunosuppression African Americans, Hispanic Americans, Asian Americans
Pathophysiology
POTTS DISEASE
(DAVIDS DISEASE/ TB OF THE BONE)
Risk Factor: Close contact with people with active PTB Poor socioeconomics Malnutrition Immuno-compromised people Living in crowded area Health care workers Therapeutic immunosuppression African Americans, Hispanic Americans, Asian Americans
Pathophysiology Contd
Mode of transmission: Inhalation of airborne droplets (Mycobacterium tuberculae)/Hematogenous The anterior aspect of the vertebral body adjacent to the subchondral plate is usually affected.
M.tuberculae spreads to adjacent interval disc between two (2) infected vertebrae
Pathophysiology Contd
Signs and Symptoms: Manifests as a combination of osteomyelitis and arthritis that usually involves more than 1 vertebra: 1. Back pain 4. Night sweats 2. Weight loss 5.Loss of appetite 3. Fatigue and general malaise 6. Pain and stiffness of the spine
Progressive bone destruction Vertebral collapse
Pathophysiology Contd
Kyphosis Pathognomonic Sign: (+) Gibbus formation Spinal canal can be narrowed by abscesses, granulation tissue or direct dural invasion
Diagnostic Examination
Blood test Skin test
Medical Management
Non-operative Anti-TB drugs (Refampacin, Isoniazid, Pyrazinamide, Ethambutol, and Streptomycin) Immobilisation of the spine is usually for 2 or 3 months Taylor Brace Surgical
Drainage of abscess Anterior decompression with spinal fusion/Lumbar Spine Pedicle Screw Fixation Fusion
Nursing Care
Assess pain Assess ROM in all extremities Promote bed rest Advise and emphasize proper diet Advise increase fluid intake within cardiac limit Maintain skin integrity Patient education
Prognosis
Current treatment modalities are highly effective against Potts disease if the disorder is not complicated by severe deformity or established neurologic deficit. Deformity and motor deficit are the most serious consequences of Potts disease and continue to be a serious problem when diagnosis is delayed or presentation of the patient is in advanced stages of the disease.
Prognosis Contd
Therapy compliance and drug resistance are additional factors that significantly affect individual outcomes. Paraplegia resulting from cord compression caused by the active disease usually responds well to chemotherapy. However, paraplegia can manifest or persist during healing because of permanent spinal cord damage.
The End